OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also seizures, anticonvulsants

• juvenile myoclonic epilepsy - esp. if sleep deprivation or excess alcohol; responds well to valproate;
• partial seizures with secondary generalisation - often resistant to antiepileptic drug Rx.
• abnormal EEG
• epileptogenic lesion on neuroimaging

• childhood absence epilepsy - often remits in adult life
• benign rolandic epilepsy - often sleep-related; respond well to carbamazepine;
• normal EEG
• normal neuroimaging
• onset in childhood
• no seizures for more than 2yrs prior to antiepileptic drug withdrawal
• monotherapy
• no seizures following introduction of antiepileptic drug
• normal intellect

• consider withdrawing after 2yrs seizure free in children and 3 years in adults if low risk for recurrence

inform patient of seizure risk, and this risk is greatest in 1st 12months of withdrawal.

• should not drive for full period of withdrawal and for 3 months thereafter unless experienced consultant feels seizure risk is low.
• reinforce usual seizure safety - eg. not swimming alone; avoid heights; shower instead of bathing;
• avoid factors that provoke seizures - sleep deprivation, alcohol, drugs, etc.
• if on multiple drugs, withdraw one at a time
• withdrawal should be gradual over 6 mths, thus unless low dose, decrease daily dose every 4 weeks by:
  • phenobarbitone 30mg
  • phenytoin 50mg
  • carbamazepine 100mg
  • sodium valproate (Epilim) 200mg
  • primidone 125mg
• ref: Australian Prescriber vol27:5 Oct 2004