Fear of long term side-effects, cost, stigmatization, inconvenience, and teratogenesis are some reasons patients desire to pursue a trial of AED taper. Many desire a trial to "see" (if they would be successful), and few regret trying despite failure of successful withdrawal. Many studies address relapse rates and predictive factors and most involve children. Pooled heterogeneous studies suggest overall about 40% or less will reoccur at 2-5 year seizure-free follow-up1. Unfavorable clinical risks in our patient include an age of onset > 16 years, seizures after the start of AEDs, and the presence of GTC seizures. EEG abnormalities may be associated with a greater risk of failure and the presence of generalized spike-and-waves may be of particular importance2. After the CAA-EEG, our patient was admitted for in-patient vEEG where frequent electro-clinical absence seizures without awareness were identified. Juvenile absence epilepsy was diagnosed and AED conversion to a broad spectrum long-term monotherapy with LTG was initiated to minimize the worsening effect that narrow-spectrum drugs may have produced. Follow-up with CAA-EEG has been suggested to judge efficacy.
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