Archives of Neuroscience

Published by: Kowsar

Strategies of Starting and Stopping Antiepileptic Drugs in Patients With Seizure or Epilepsy; A Comprehensive Review

Majid Ghaffarpour 1 , * , Hossein Ali Ghelichnia 1 , Mohammad Hossein Harrichian 1 , Mojdeh Ghabaee 1 , Mohammad Mahdi Saber Tehrani 1 and Parviz Bahrami 2
Authors Information
1 Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
2 Department of Neurology, Lorestan University of Medical Sciences, Khorramabad, IR Iran
Article information
  • Archives of Neuroscience: October 01, 2014, 1 (3); e14182
  • Published Online: October 1, 2014
  • Article Type: Review Article
  • Received: September 25, 2013
  • Revised: November 30, 2013
  • Accepted: December 29, 2013
  • DOI: 10.5812/archneurosci.14182

To Cite: Ghaffarpour M, Ghelichnia H A, Harrichian M H, Ghabaee M, Saber Tehrani M M, et al. Strategies of Starting and Stopping Antiepileptic Drugs in Patients With Seizure or Epilepsy; A Comprehensive Review, Arch Neurosci. 2014 ; 1(3):e14182. doi: 10.5812/archneurosci.14182.

Copyright © 2014, Tehran University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Context
2. Evidence Acquisition
3. Results
4. Discussion
  • 1. Jallon P. Epilepsy and epileptic disorders, an epidemiological marker? Contribution of descriptive epidemiology. Epileptic Disord. 2002; 4(1): 1-13[PubMed]
  • 2. Hauser WA. Epidemiology of epilepsy in children. Neurosurg Clin N Am. 1995; 6(3): 419-29[PubMed]
  • 3. Samuels MA, Ropper AH. Samuel's Manual of Neurologic Therapeutics. 2010; : 38
  • 4. Warlow C, Hankey GJ. The Lancet Handbook of Treatment in Neurology. 2006; : 30
  • 5. Hauser WA, Hesdorffer DC, Epilepsy Foundation of America . Epilepsy: frequency, causes and consequences. 1990;
  • 6. Hauser WA, Rich SS, Lee JR, Annegers JF, Anderson VE. Risk of recurrent seizures after two unprovoked seizures. N Engl J Med. 1998; 338(7): 429-34[DOI][PubMed]
  • 7. O'Dell C, Shinnar S. Initiation and discontinuation of antiepileptic drugs. Neurol Clin. 2001; 19(2): 289-311[PubMed]
  • 8. Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005; 365(9476): 2007-13[DOI][PubMed]
  • 9. Berg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia. 2008; 49 Suppl 1: 13-8[DOI][PubMed]
  • 10. Schmidt D. AED discontinuation may be dangerous for seizure-free patients. J Neural Transm. 2011; 118(2): 183-6[DOI][PubMed]
  • 11. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005; 46(4): 470-2[DOI][PubMed]
  • 12. McCormick DA, Contreras D. On the cellular and network bases of epileptic seizures. Annu Rev Physiol. 2001; 63: 815-46[DOI][PubMed]
  • 13. Faingold CL. Emergent properties of CNS neuronal networks as targets for pharmacology: application to anticonvulsant drug action. Prog Neurobiol. 2004; 72(1): 55-85[DOI][PubMed]
  • 14. Chang BS, Lowenstein DH. Epilepsy. N Engl J Med. 2003; 349(13): 1257-66[DOI][PubMed]
  • 15. Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med. 1987; 316(9): 493-8[DOI][PubMed]
  • 16. Tarkka R, Rantala H, Uhari M, Pokka T. Risk of recurrence and outcome after the first febrile seizure. Pediatr Neurol. 1998; 18(3): 218-20[PubMed]
  • 17. Victor M. 33. The pathophysiology of alcoholic epilepsy. Res Publ Assoc Res Nerv Ment Dis. 1968; 46: 431-54
  • 18. Ropper A, Samuels M. Adams and Victor's Principles of Neurology. 2009; 2: 1137
  • 19. Daroff RB, Bradley WG, Fenichel GM, Jankovic J, Mazziotta JC. Bradley's Neurology in Clinical Practice. 2012; : 1348
  • 20. Scorza FA, Albuquerque M, Arida RM, Cysneiros RM, Henriques TM, Scorza CA, et al. Seizure occurrence in patients with chronic renal insufficiency in regular hemodialysis program. Arq Neuropsiquiatr. 2005; 63(3B): 757-60[PubMed]
  • 21. Glantz MJ, Cole BF, Forsyth PA, Recht LD, Wen PY, Chamberlain MC, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000; 54(10): 1886-93[PubMed]
  • 22. Brunton LL, Gilman A, Goodman LS. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 2006; : 519
  • 23. Horwitz NH. Library: Historical Perspective. Neurosurgery. 1994; 35(1): 168
  • 24. Temkin NR. Preventing and treating posttraumatic seizures: the human experience. Epilepsia. 2009; 50 Suppl 2: 10-3[DOI][PubMed]
  • 25. Temkin NR. Neurology and Trauma. 1996; : 149
  • 26. Awad I, Jabbour P. Cerebral cavernous malformations and epilepsy. Neurosurg Focus. 2006; 21(1)[PubMed]
  • 27. Menon B, Shorvon SD. Ischaemic stroke in adults and epilepsy. Epilepsy Res. 2009; 87(1): 1-11[DOI][PubMed]
  • 28. Johnson RT, Griffin JW, McArthur JC. Current Therapy in Neurologic Disease. 2006; : 224
  • 29. Rowland LP, Pedley TA, Merritt HH. Merritt's Neurology. 2010; : 935
  • 30. Gilmore E, Choi HA, Hirsch LJ, Claassen J. Seizures and CNS hemorrhage: spontaneous intracerebral and aneurysmal subarachnoid hemorrhage. Neurologist. 2010; 16(3): 165-75[DOI][PubMed]
  • 31. Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1991; 41(7): 965-72[PubMed]
  • 32. Kim LG, Johnson TL, Marson AG, Chadwick DW, Mrc Mess Study group . Prediction of risk of seizure recurrence after a single seizure and early epilepsy: further results from the MESS trial. Lancet Neurol. 2006; 5(4): 317-22[DOI][PubMed]
  • 33. Leppik IE. Contemporary Diagnosis and Management of The Patient With Epilepsy. 2001; : 56
  • 34. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000; 342(5): 314-9[DOI][PubMed]
  • 35. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology. 1993; 43(3 Pt 1): 478-83[PubMed]
  • 36. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients--summary statement. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1996; 47(2): 600-2[PubMed]
  • 37. Randomised study of antiepileptic drug withdrawal in patients in remission. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Lancet. 1991; 337(8751): 1175-80[PubMed]
  • 38. Shih JJ, Ochoa JG. A systematic review of antiepileptic drug initiation and withdrawal. Neurologist. 2009; 15(3): 122-31[DOI][PubMed]
  • 39. Specchio LM, Beghi E. Should antiepileptic drugs be withdrawn in seizure-free patients? CNS Drugs. 2004; 18(4): 201-12[PubMed]
  • 40. Specchio LM, Tramacere L, La Neve A, Beghi E. Discontinuing antiepileptic drugs in patients who are seizure free on monotherapy. J Neurol Neurosurg Psychiatry. 2002; 72(1): 22-5[PubMed]
  • 41. Callaghan N, Garrett A, Goggin T. Withdrawal of anticonvulsant drugs in patients free of seizures for two years. A prospective study. N Engl J Med. 1988; 318(15): 942-6[DOI][PubMed]
  • 42. Lossius MI, Hessen E, Mowinckel P, Stavem K, Erikssen J, Gulbrandsen P, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia. 2008; 49(3): 455-63[DOI][PubMed]
  • 43. Cardoso TA, Coan AC, Kobayashi E, Guerreiro CA, Li LM, Cendes F. Hippocampal abnormalities and seizure recurrence after antiepileptic drug withdrawal. Neurology. 2006; 67(1): 134-6[DOI][PubMed]
  • 44. Camfield P, Camfield C. When is it safe to discontinue AED treatment? Epilepsia. 2008; 49 Suppl 9: 25-8[DOI][PubMed]
  • 45. Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology. 1994; 44(4): 601-8[PubMed]
  • 46. Verrotti A, Morresi S, Basciani F, Cutarella R, Morgese G, Chiarelli F. Discontinuation of anticonvulsant therapy in children with partial epilepsy. Neurology. 2000; 55(9): 1393-5[PubMed]
  • 47. Hixson JD. Stopping antiepileptic drugs: when and why? Curr Treat Options Neurol. 2010; 12(5): 434-42[DOI][PubMed]
  • 48. Serra JG, Montenegro MA, Guerreiro MM. Antiepileptic drug withdrawal in childhood: does the duration of tapering off matter for seizure recurrence? J Child Neurol. 2005; 20(7): 624-6[PubMed]
  • 49. Hessen E, Lossius MI, Reinvang I, Gjerstad L. Influence of major antiepileptic drugs on neuropsychological function: results from a randomized, double-blind, placebo-controlled withdrawal study of seizure-free epilepsy patients on monotherapy. J Int Neuropsychol Soc. 2007; 13(3): 393-400[DOI][PubMed]
  • 50. Hessen E, Lossius MI, Reinvang I, Gjerstad L. Slight improvement in mood and irritability after antiepileptic drug withdrawal: a controlled study in patients on monotherapy. Epilepsy Behav. 2007; 10(3): 449-55[DOI][PubMed]
  • 51. Pourmahmoodian H, Kahani M, Ghaffarpour M, Harrirchian MH, Ghabaee M, Fallah A. Ictal and interictal EEG abnormalities in 100 migraineurs with and without aura. Acta Medica Iranica. 2007; 45(4): 309-15
  • 52. Jallon P, Loiseau P, Loiseau J. Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Coordination Active du Reseau Observatoire Longitudinal de l' Epilepsie. Epilepsia. 2001; 42(4): 464-75[PubMed]
  • 53. Tao JX, Ray A, Hawes-Ebersole S, Ebersole JS. Intracranial EEG substrates of scalp EEG interictal spikes. Epilepsia. 2005; 46(5): 669-76[DOI][PubMed]
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