Patient is a known case of epilepsy, taking levetiracetam 1 gm BD. He is now seizure free from 2 years but he developed agitation and anger issues interfering with day to day activities as a result of the drug intake. What should be the next best step?
(A) Stop levetiracetam and sta on a different antiepileptic (B) Discontinue the drug as he is seizure free (C) Slowly taper the drug over next 6 months (D) Continue levetiracetam since a 5-year seizure free interval is needed
(C) Answer- C. Slowly taper the drug over next 6 monthsStopping or switching an antiepileptic is based on seizure free period & compliance or adverse effects of the drug.Withdrawal of therapy should be gradual over 2-3 monlhs, in the question 6 months. Anti-epileptic drug therapy shouldnever he stopped abruptly. Even if new drug is to be added/replaced, the previous drug should be gradually stoppedotherwise it can lead to breakthrough seizures.