Although anti-epileptic medications (AEDs) are usually effective at stopping seizures, they have known adverse effects and should be discontinued when possible. Unfortunately, the optimum time to taper medication is not known.

Waiting until the child has been seizure free for 2 or more years has some support in the literature and is common practice; the majority of children with seizures will go into remission within this time. [Sirven: 2001] [Tennison: 1994] Remission is more likely if the child is between 5 and 9 years old and has idiopathic epilepsy. (Juvenile myoclonic epilepsy is an exception; although this is a benign idiopathic epilepsy, most individuals will need to be on medication indefinitely.) [Berg: 2001] [Gherpelli: 1992] [Specchio: 2004]

If the patient has been on the medication for a long time and the goal is to stop medication, the dose should be decreased once a week over a few weeks before finally stopping the medication. There is no data about the exact way to taper, but going to 3/4 of the dose the first week, 1/2 the second week, and 1/4 the third week is 1 approach. It is known that stopping seizure medications abruptly increases the risk of seizures. [Malow: 1993] However, tapering over a longer period (e.g., greater than three months) does not seem to be better than tapering over a period of weeks. [Ranganathan: 2006] [Serra: 2005] [Tennison: 1994] Seizure recurrence is most likely in the first few months after withdrawal and for up to 6 months. Remind the family of seizure precautions during this time (e.g., extra care when in the water, climbing, etc.), and document this in the chart. (See Missing issue with id: 870d7bba.xml.)
In general, seizure relapses occur in approximately 1/3 of children who have been withdrawn from antiepileptic medication.[Gherpelli: 1992] [Shinnar: 1994] [Camfield: 2005] There may be a very small chance of seizures becoming intractable to medication after a failed attempt at medication withdrawal; parents should be informed of this unlikely possibility. [Camfield: 2005] [Schmidt: 2005]

Except for children who are typically developing with idiopathic epilepsy, such as absence epilepsy, involving a pediatric neurologist may be helpful in deciding whether or not to taper medication.