When Can You Stop Childhood Absence Epilepsy Medicine?

After your child has been completely free of all seizure types (not just absence seizures) for at least two years, their neurologist may consider them for a supervised medication withdrawal ^[1][2]. This two-year mark is a common time to evaluate the risks and benefits of continuing treatment, but there is no universal cutoff that guarantees safety ^[1].

The Two-Year Milestone

Because Childhood Absence Epilepsy (CAE) is often outgrown, many families choose to try a supervised withdrawal to avoid unnecessary long-term medication use. In specific cohort studies of children with CAE, estimates of relapse vary but often suggest that 14% to 17% of children may experience a return of seizures, meaning the vast majority remain seizure-free ^[3][4].

However, individual risk varies widely. Neurologists are typically more cautious about weaning if a child has a history of generalized tonic-clonic seizures (convulsions that affect the whole body) or if they required multiple medications to get their seizures under control ^[3].

The Role of the EEG

Before making a decision, the neurologist will likely order an electroencephalogram (EEG) to record the child’s brain waves. During this test, the child is often asked to breathe heavily (hyperventilate). Supervised hyperventilation is used because it can bring out characteristic brain wave patterns and sometimes brief absence spells that are otherwise hidden ^[5].

While a completely normal EEG is reassuring, it does not guarantee a successful withdrawal ^[6]. Conversely, some minor EEG abnormalities do not automatically mean your child will relapse ^[6]. The doctor will interpret the EEG alongside your child’s full medical history and the exact length of time they have been seizure-free ^[6][2].

The Tapering Process

If a trial off medication is chosen, the dose must be decreased very slowly. The tapering speed varies by medication, dose, and the neurologist’s preference, but it is typically gradual and done over several weeks or longer ^[7].

Never stop or change your child’s medication dose without the prescriber’s instructions. Abruptly stopping medication can allow seizures to recur rapidly and, depending on the medication, can contribute to serious, prolonged seizures ^[7].

What to Watch For and Emergency First Aid

If a relapse occurs, it is most common within the first year (one study found an average relapse time of 9 months), but the risk never falls entirely to zero ^[3]. During the taper and for the following months, caregivers and teachers should watch for:

• Return of brief staring spells, eye fluttering, or unresponsiveness
• Unexplained drops in attention or school performance (though these are non-specific and should be discussed with your doctor to avoid jumping to conclusions)
• New types of seizures, such as convulsions ^[8]

If you suspect a brief absence spell, keep a diary noting the date, how long it lasted, and any triggers. Try to record a video if safe to do so, and contact your neurologist. While many children regain seizure control if medication is restarted, you should never restart the old dose on your own ^[7].

If your child experiences a convulsion (generalized tonic-clonic seizure):

• Time the seizure.
• Protect them from injury and place them on their side when practical.
• Do not restrain them and do not put anything in their mouth.
• Call 911 or seek emergency medical help if the seizure lasts 5 minutes or more, if seizures repeat without recovery, if they have difficulty breathing, or if this is their first convulsion.