Initiation and discontinuation of antiepileptic drugs.

The issues of when to initiate and discontinue antiepileptic drugs (AEDs) are reviewed using an approach that emphasizes weighing the relative risks and benefits of the therapeutic decisions. The majority of children and adults who present with a first unprovoked seizure will not experience further seizures. Treatment reduces recurrence risk but does not alter long-term prognosis. Treatment should be deferred until a second seizure has occurred. The majority of children and adults who are seizure free for two or more years on medications will remain so when medications are withdrawn. The risk of reoccurrence is somewhat higher in adults. The consequences of recurrence are much more significant in adults. Most children who are seizure free on medications should have at least one attempt at medication withdrawal. In adults, the decisions need to be individualized based on a variety of factors including age, sex, occupation, and the presence or absence of risk factors for reoccurrence.