American Board of Internal Medicine (ABIM) Certification Practice Exam

For how long should a patient be seizure-free before considering weaning off AEDs?

1. 6 months

2. 1 year

3. 2-4 years

4. 5 years

The correct answer is: 2-4 years

The recommended duration of being seizure-free before considering the weaning off antiepileptic drugs (AEDs) is generally 2 to 4 years. This timeframe allows for a substantial observation period to ensure the patient's seizures are well controlled and to assess the long-term prognosis of seizure recurrence. A longer seizure-free period decreases the likelihood of recurrence after the medication is discontinued. Many clinical guidelines suggest this 2 to 4 year window as it balances the potential risks of seizures returning against the benefits of reducing medication and its associated side effects. The longer a patient has been seizure-free, the greater the chance that the seizures were an isolated incident or that they will remain controlled without the need for AEDs. A follow-up period shorter than 2 years may not provide sufficient reassurance regarding the patient's stability, while waiting longer than 4 years could unnecessarily prolong treatment in patients who may not require ongoing therapy.