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In general, patients who do not have good control with medications after the first year are more likely to have difficulty with epilepsy treatment. Other indications of more difficult-to-control epilepsy are:
- Multiple types of seizures have occurred
- Abnormal EEG readings
- Abnormal neurologic findings on physical exam
- Lesion or abnormality seen on MRI scan
Most patients who have responded well to medications can stop taking AEDs within 5 - 10 years. Evidence suggests that medications in children should not be halted for at least 2 years after the last seizure, particularly if they have partial seizures and abnormal EEGs. It is not clear whether children who have been free of generalized seizures need to wait more than 2 years or if they can withdraw earlier.
Children who tend to relapse after withdrawal from treatment usually have the following conditions or situations:
- A family history of epilepsy
- Require multiple medications to control seizures
- Abnormal EEG readings after treatment has started
- Partial seizures
Treatment of the Elderly
Anti-epileptic drugs interact with many other drugs, and may cause special problems in older patients who use multiple medications for other health problems. Elderly patients should have liver and kidney function tests performed before starting antiseizure medication. Standard drugs are usually effective, while newer ones (including gabapentin, lamotrigine, oxcarbazepine, and gamma-vinyl-GABA) may sometimes be used as a sole therapy. These newer drugs also tend to have fewer side effects than the older ones.
Treatment During Pregnancy
Preparing to Become Pregnant. Women with epilepsy who are considering pregnancy should talk to their doctors before they become pregnant. According to practice guidelines from the American Academy of Neurology and the American Epilepsy Society:
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Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
