Background
Epilepsy is a disorder where recurrent seizures (fits) are caused by abnormal electrical discharges of the brain. Antiepileptic medicines are used to prevent these seizures. Regular intake of antiepileptic medicines may have long‐term side effects. When in remission (free of seizures for some time), it is logical to attempt to stop the medicines. Two important issues are how and when to stop them.
Aim of the review
This review analyzed studies for evidence regarding rapidity of withdrawal of antiepileptic medicines. We included randomized controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) evaluating the rapid or slow withdrawal (tapering down) of these medicines after varying periods of seizure control in people with epilepsy.
Results
We included only two small studies conducted in 206 children with epilepsy. The included studies found no difference in the proportion of participants remaining seizure‐free between the rapid‐ and the slow‐tapering groups at different time points. There were no data for other measures such as status epilepticus (a long seizure), death, illness relating to seizures, and quality of life. We found no completed trials investigating antiepileptic medicine withdrawal in adults.
Currently, one Italian trial is ongoing that is investigating if a slow or a rapid withdrawal schedule of antiepileptic medicine influences return of seizures (relapse) in adults with epilepsy who have been seizure free for at least two years (no preliminary results available).
Reliability of the evidence
Evidence from the two included studies was of very low reliability. Both studies were conducted in a small number of participants and there were not enough data to detect a difference between the groups. Furthermore, they included only children, hence the results cannot be generalized to adults. Therefore, no reliable evidence is currently available on the optimal rate of tapering of antiepileptic medicines.
The evidence is current to November 2021.
Font: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005003.pub4/full/es
