Anti-Seizure Drug Discontinuation in Individuals with Epilepsy: Single-Centre Experiences — When, How Long, How?

Abstract

Aims: The present study aimed to evaluate seizure recurrence rates after anti-seizure medication (ASM) discontinuation in adults with epilepsy and to identify clinical and treatment-related factors associated with relapse.

Study Design: Retrospective observational single-center study.

Place and Duration of Study: This study was conducted at the Department of Neurology, Hitit University Faculty of Medicine Hospital. Patient data collected between December 2013 and January 2025 were retrospectively analyzed.

Methodology: Adult patients with epilepsy who had been seizure-free for at least 2 years and whose ASM therapy was gradually discontinued under neurologist supervision were included. Only patients with normal neurological examination findings, normal cranial Magnetic Resonance Imaging (MRI), and regular follow-up data were analyzed. Demographic characteristics, age at onset, seizure type, duration of seizure-free period prior to discontinuation, treatment modality (monotherapy vs polytherapy), Electroencephalography (EEG) findings before withdrawal, tapering duration, and seizure recurrence were evaluated.

Results: Out of 1,538 epilepsy patient files reviewed, ASM therapy was discontinued in 424 patients (27.6%). The cohort included 189 females (44.6%) and 235 males (55.4%), with a mean age of 46.8±15.2 years. Seizure recurrence occurred in 88 patients (20.8%) either during dose reduction or after complete withdrawal. Recurrence was significantly associated with shorter seizure-free duration, polytherapy, abnormal EEG findings, and shorter tapering periods.

Conclusion: ASM discontinuation is a critical stage in epilepsy management and remains a complex clinical decision. Individualized withdrawal strategies considering clinical risk factors may help reduce relapse rates and improve long-term outcomes.