Off to College: Safe to Stop His Antiepileptic Drug?

Charles P. Vega, MD

Disclosures

March 23, 2020

In this edition of Cases in Deprescribing, I present another clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in "comments," particularly if you disagree with me.

A Teen Wants to Go to College Without Antiepileptics

This patient is an adolescent, aged 17, with idiopathic generalized seizure disorder. He had his first seizure at age 12 and underwent a workup including head MRI and EEG, but no cause for his seizures was found. He was started on lamotrigine and had two subsequent seizures, at ages 12 and 14. His most recent seizure followed a period of medication nonadherence, but he has dutifully taken his lamotrigine since then. His current dose is 150 mg twice daily.

His parents report that he has refused to see his neurologist for the past 2 years despite multiple referrals from the primary care physician's office.

The patient's vital signs are normal, and he has no evidence of growth delay or cognitive dysfunction. His physical examination, including neurologic examination, is normal.

The patient is very insistent that he wants to stop his lamotrigine altogether before he goes off to college in 6 months, although his parents are worried about the risk for recurrent seizures.

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