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

Seizure is a transient neurologic dysfunction caused by sudden abnormal firing of cerebral neurons. Epileptic syndrome is a complex of symptoms and signs that is characterized by not only the etiology but also the age at onset, seizure type, pattern of electroencephalography and prognosis. Treatment of the first seizures depends on their nature; some of them need no antiepileptic drugs (AED) therapy whereas the others should be treated appropriately. AEDs have long- and short-term adverse effects, interaction with other medications, and occupational and/or psychological consequences. Therefore, discontinuation of AEDs should be considered after a free-seizure period. Studies show that the rate of seizure recurrence after AEDs withdrawal is about two to three times more than those who continue therapy; thus, the most difficult decision facing a neurologist is when to start medication and when/how it should be discontinued. This review explores the literature to answer above questions.