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Benzodiazepine taper — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Benzodiazepine taperUSMLE Step 3

A 34-year-old woman has remained seizure-free for 4 years on levetiracetam after two unprovoked seizures. Neurologic examination, MRI, and current EEG are normal. She wants to stop medication before pregnancy. What is the best response?

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Reveal the answer and explanation

Correct answer: B — Discuss recurrence risk and taper levetiracetam gradually if chosen

The best answer is “Discuss recurrence risk and taper levetiracetam gradually if chosen”. Long seizure freedom and reassuring studies support discussing withdrawal but do not eliminate recurrence risk. The decision is shared and medication is tapered rather than abruptly stopped, with driving and pregnancy counseling. Withdrawal after sustained seizure freedom is individualized and gradual after shared risk assessment.

Reference: AAN Practice Advisory: Antiseizure Medication Withdrawal: https://pubmed.ncbi.nlm.nih.gov/34873018/