Gabapentin Withdrawal-Related Seizures
Gabapentin abrupt discontinuation can precipitate withdrawal-related seizures, including status epilepticus. [1] Published evidence consists mainly of case reports and review descriptions, so the true incidence rate is not well quantified. [2]
Evidence Quality and How “Rare” Is Determined
The gabapentin U.S. prescribing information includes withdrawal-related seizure as a labeled risk. [1] The available literature for withdrawal seizures is dominated by case reports rather than prospective incidence studies, which limits ability to estimate how often withdrawal seizures occur after abrupt cessation. [2]
Clinical Circumstances Associated With Withdrawal Seizures
Withdrawal seizures are described as occurring after abrupt discontinuation, particularly in patients with epilepsy or other seizure predisposition. [1] Status epilepticus after gabapentin withdrawal has been reported even in settings without prior seizure history. [3]
Discontinuation Practice Recommendations
Abrupt discontinuation should be avoided because it can increase seizure frequency and precipitate withdrawal seizures. [1] Gradual tapering is recommended to reduce risk of withdrawal-related seizures or status epilepticus. [2]
Bottom-Line Clinical Interpretation
Seizures due to gabapentin abrupt discontinuation are considered a recognized but uncommon event, based on the mismatch between a labeled risk and the paucity of incidence data. [1], [2] Case reports confirm that severe outcomes can occur, so tapering is clinically important even though population-level incidence is uncertain. [1], [3]