Monitoring
Traditionally patients are followed up in clinic approximately every 6 months while on antiepileptics, but this may vary depending on seizure frequency and severity. In general, patients are monitored clinically to assess seizure control. Parental and close family member observations are heavily relied upon to determine frequency and appearance of seizures. Medication adjustments are made according to seizure control. Periodic monitoring of drug levels and other laboratory studies (e.g., CBC, liver enzyme tests) are often warranted to check for compliance and potential adverse drug effects, depending on the medication.
There are some data to suggest that normalization of routine EEG indicates good treatment response and a better chance of remission. In general, repeat routine EEGs are not indicated unless there is a change in the observable manifestations of the seizures that suggest the underlying localization and/or epilepsy syndrome, and therefore the possibility exists that a patient has an alternative epilepsy syndrome. If a patient is having persistent or frequent atypical episodes, prolonged EEG monitoring may be necessary to capture and characterize events.
Patients who achieve seizure freedom may eventually wish to discontinue anticonvulsant medications. See Management approach.
A trial withdrawal of medications may be considered if a patient with childhood absence epilepsy (CAE) has been seizure free for a period of 1 to 2 years.[90] One review did not find sufficient evidence to establish when to withdraw medications in children with generalized seizures.[91]
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The decision to withdraw medication is individualized, and may in part be made informed by patient age at presentation. For example, a child who was diagnosed at age 8 or 9 years may be a good candidate for a medication wean after 2 years, whereas a child who presented at age 6 years might be maintained on medication longer.
Patients with any syndrome other than CAE may require prolonged treatment. However, a trial off medications can be considered if the patient has been seizure free for 2 years.
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