Stopping antiseizure drugs

A 32-year-old, right-handed white male with a history of well-controlled epilepsy is evaluated because he is interested in stopping his antiepileptic drug (AED). He developed epilepsy manifested as infrequent focal seizures that evolved into convulsions when he was 28 years of age. He exhibited one type of seizure semiology and became seizure free following initiation of AEDs. The cause for his epilepsy was felt to be due to a motor vehicle accident which resulted in a traumatic brain injury. A brain MRI performed just after the accident showed a small amount of hemosiderin deposition in the right frontal lobe affecting the cortex. His current AED regimen is 1,000 mg of oral levetiracetam twice a day. He had not had a seizure in more than 2 years. He was working full time and was driving a car. While he does not report having any side effects from his medication, he does not like taking it, and is concerned about the cost of continuing use. His last EEG was performed 2 years ago and showed intermittent theta-delta slowing over the right frontal head region, but was otherwise normal (Fig. 16.1). His neurological examination in the clinic was normal.