Stopping drug treatment
Once seizures have been controlled for a while, you may wonder whether it is possible to stop taking medication. According to Epilepsy and the Family: A New Guide by Richard Lechtenberg, M.D., there is around a 40 per cent chance of seizures returning if drug treatment is stopped, but unfortunately there is no way of knowing for sure which particular individuals will be affected, though doctors may be able to make an informed guess depending on your type of epilepsy.

The most likely forms of epilepsy to respond well to treatment are juvenile myoclonic epilepsy (JME) and the related syndrome of tonic-clonic seizures on awakening. JME consists of someone having tonic-clonic seizures within two hours of awakening, plus, if leading questions are asked, a history of sudden jerks.

Seizure return is more likely with certain types of seizure, including myoclonic, atonic, tonic and partial seizures, as well as West Syndrome and Lennox-Gastaut Syndrome. Total control is incredibly rare. Research has also shown that other factors increase the risk of recurrence, including a known cause for the epilepsy, seizures which began after age 12, a family history of epilepsy, and a history of atypical febrile seizure, and an abnormal EEG. Other research has found that the longer the seizure-free interval before withdrawal, and the fewer drugs needed for initial seizure control, the greater the likelihood of successful remission.

Your doctor may agree that you could try drug withdrawal after five years of being seizure-free (one to two years if a child). This has to be a calculated risk, bearing in mind the implications for matters such as career and driving. Drugs will be tapered off gradually, with the dosage reduced over a three-to-six-month period. It is important that you adhere faithfully to this doctor-monitored reduction, and that you don’t try and ‘come off the drugs yourself. Suddenly stopping medication can be dangerous as it may lead to status epilepticus. You should not drive while treatment is being reduced and for six months (DVLA regulations). If a seizure occurs, then in the UK it is one year before driving can restart.

If seizures do return, they normally do so relatively soon, within a few weeks or months, and are usually the same kind as before. According to Epilepsy and the Family: A New Guide by Richard Lechtenberg, M.D., 50 per cent of seizures which return do so within six months of stopping medication, 60-80 per cent within a year, and virtually all within two years. If seizures do recur, total control on restarting anti-epileptic drugs therapy is likely.