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Stroke Doc
Stroke Doc, Board Certified Physician
Category: Neurology
Satisfied Customers: 51
Experience:  I am board-certified in Neurology and the subspecialty Vascular Neurology.
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My doctor is tapering me off Keppra. I am now taking only

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My doctor is tapering me off Keppra. I am now taking only 125 MG per day. I am afraid to stop completly for fear of withdrawal seizures. If I stop completely, will I have another seizure? How long before I will know I am seizure free?My doctor is not very helpful. Thank You.
Submitted: 5 years ago.
Category: Neurology
Expert:  Stroke Doc replied 5 years ago.

The answer to your question depends upon numerous things, including your seizure type and cause, your genetics, etc. 125 mg daily usually is not effective in preventing seizures, so weaning off completely usually would do very little to change the risk of seizure compared to being on the 125 mg daily dose. (I would say most adult patients on such a low dose aren't being protected from seizures at all.) If you stop completely, will you have another seizure? No one can say. If you have a seizure disorder (epilepsy), you're certainly at risk of another seizure whether you're on the medication (or even a high dose of the medication) or not. You're just less likely to have a seizure on a good dose of an appropriate seizure medication. There's no time period that can adequately say a person is "seizure-free." Seizures occur sporadically in most patients with epilepsy; so going a month, a year, two years, or even longer does not guarantee seizure freedom. Many epilepsy syndromes that persist into adulthood (assuming they started in childhood) really should not be considered to have "gone away" after a couple years of seizure freedom on a medication, though they may have. It may be that the medication has done a great job reducing the risk of seizures; and when the person stops the medication, seizures recur--maybe a week later, maybe a year later, maybe 10 years later. There's unfortunately no way to predict that.

With certain epilepsy syndromes, patients should never be off a seizure medication. The most notorious is JME (juvenile myoclonic epilepsy). People with JME usually have recurrence of seizures if taken off seizure medication.

If someone was placed on a seizure medication because of a seizure that occurred after a brain hemorrhage, eventually coming off the seizure medication may be an option, though they may still be at risk for seizure. (Some patients can come off medication and never have seizures again. Some come off and eventually will have seizures again. There's no great way to predict that.)

Someone with seizures due to a brain tumor often require lifelong seizure medication regardless of how well the tumor was treated.

The unfortunate short and completely honest answer to your question is

1. If you stop completely, you may have another seizure; but your current dose is insufficient to prevent seizures in most adult patients in the first place.

2. There's simply no way to know if you are truly seizure-free. If you and your physician elect to come off seizure medication entirely, then taking appropriate safety precautions common to all seizure patients (e.g. no swimming alone, avoiding heights in an unsupervised manner, etc.) should still be your practice.

3. Check with your state's Department of Motor Vehicles regarding its laws for patients with seizures who want to drive to make sure you are complying with driving laws if you elect to come off seizure medications entirely.

I hope this helps.

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