American Board of Internal Medicine (ABIM) Certification Practice Exam

What patient characteristics increase the likelihood of remaining seizure-free after stopping AEDs?

1. History of multiple seizures

2. Normal EEG and MRI results

3. Older age

4. Having a family history of epilepsy

The correct answer is: Normal EEG and MRI results

The likelihood of remaining seizure-free after discontinuing antiepileptic drugs (AEDs) is significantly influenced by having normal EEG (electroencephalogram) and MRI (magnetic resonance imaging) results. These tests are critical in assessing the underlying characteristics of a patient’s epilepsy. Normal EEG findings indicate that there is no ongoing abnormal electrical activity in the brain that would predispose an individual to seizures. Similarly, a normal MRI suggests that there are no structural brain abnormalities contributing to the seizures. Hence, when both the EEG and MRI results are normal, this strongly implies a benign epilepsy syndrome with a good prognosis. Patients with such results typically have a higher likelihood of being seizure-free after AED withdrawal, especially if they have had a sustained period of seizure freedom while on medication. On the other hand, a history of multiple seizures or an older age does not guarantee a better outcome after stopping AEDs. In fact, multiple seizures historically can be a risk factor for recurrence after treatment discontinuation. A family history of epilepsy may indicate a genetic predisposition, which could lead to a more cautious approach regarding withdrawal from AEDs. Therefore, the best predictor of remaining seizure-free post-AED is the presence of normal EEG and MRI results.