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Employment

The young person with a history of epilepsy is more likely to find difficulty gaining
satisfactory employment. Continued remission of epilepsy greatly enhances the chance of
employment and this usually acts as a pressure to continue therapy. On rare occasions,
however, the contrary may be true. Some employers may make an offer of employment
conditional on an individual being off medications.

Driving

At 17 a young person with a history of epilepsy can gain a provisional driving licence in the
UK as long as he/she has either been free of seizures altogether for a period of one year, or
has only suffered nocturnal seizures for a period of three years. The possession of a driving
licence is a potent deterrent for the discontinuation of therapy, as any seizure occurring on
drug withdrawal will inevitably lead to its loss and this may secondarily affect employment.

Leisure pursuits

A person with epilepsy often enjoys participation in activities that might be viewed as
‘unsafe’ if a seizure were to occur. These include swimming, cycling and horse riding, all of
which can be undertaken satisfactorily with a few common-sense precautions and responsible
supervision. Such pursuits may, however, be regarded as unacceptably risky during a period
of AED discontinuation.

Contraception and pregnancy

Concern about the effect of AEDs on contraception and pregnancy is very real to young
women with epilepsy (see Chapter 44). The fact that some AEDs (phenobarbitone, phenytoin,
carbamazepine and topiramate) may reduce the efficacy of oral contraceptive agents and
necessitate the use of higher-dose oestrogen preparations may be seen by many as an
indication for considering AED withdrawal. A more potent argument, however, is the risk of
teratogenicity associated with drug therapy. Most young women contemplating pregnancy
who have been seizure free for approximately 23 years would see this as a reason for
considering a trial of AED withdrawal before pregnancy.

References

1. CHADWICK, D. (1984) The discontinuation of antiepileptic therapy. In: Recent Advances in Epilepsy, vol.2 (Eds
T.A. Pedley and B. Meldrum), pp.111-125. Churchill Livingstone, Edinburgh.

2. CHADWICK, D. and REYNOLDS, E.H. (1985) When do epileptic patients need treatment? Starting and stopping
medication. Br Med J 290, 1885-1888.

3. MRC Antiepileptic Drug Withdrawal Group (1991) Randomised study of antiepileptic drug withdrawal in patients
in remission. Lancet 337, 1175-1180.