Open AccessReducing versus stopping antiepileptic medications after temporal lobe surgery
Author(s) -
Yardi Ruta,
Irwin Anna,
Kayyali Husam,
Gupta Ajay,
Nair Dileep,
GonzalezMartinez Jorge,
Bingaman William,
Najm Imad M.,
Jehi Lara E.
Publication year - 2014
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.35
Subject(s) - medicine , discontinuation , epilepsy , hippocampal sclerosis , hazard ratio , temporal lobe , antiepileptic drug , pediatrics , epilepsy surgery , surgery , retrospective cohort study , anterior temporal lobectomy , anesthesia , confidence interval , psychiatry
Objective To study the safety of antiepileptic drug ( AED ) withdrawal after temporal lobe epilepsy ( TLE ) surgery. Methods We reviewed patients who underwent TLE surgery from 1995 to 2011, collecting data on doses, dates of AED initiation, reduction, and discontinuation. Predictors of seizure outcome were defined using Cox‐proportional hazard modeling and adjusted for, while comparing longitudinal seizure‐freedom in patients for whom AED s were unchanged after resection as opposed to reduced or stopped. Results A total of 609 patients (86% adults) were analyzed. Follow‐up ranged from 0.5 to 16.7 years. Most (64%) had hippocampal sclerosis. Overall, 229 patients had remained on their same baseline AED s, while 380 patients stopped (127 cases) or reduced (253 cases) their AED s. Mean timing of the earliest AED change was shorter in patients with recurrent seizures (1.04 years) compared to those seizure‐free at last follow‐up (1.44 years; P ‐value 0.03). Whether AED s were withdrawn 12 or 24 months after surgery, there was a 10–25% higher risk of breakthrough seizures within the subsequent 2 years. However, 70% of patients with seizure recurrence after AED discontinuation reachieved remission, as opposed to 50% of those whose seizures recurred while reducing AED s ( P = 0.0001). Long‐term remission rates were similar in both AED discontinuation and “unchanged” groups (82% remission for AED s withdrawn after 1 year and 90% for AED s withdrawn after 2 years), while only 65% of patients whose recurrences started during AED reduction achieved a 2‐year remission by last follow‐up. Interpretation AED withdrawal increases the short‐term risk of breakthrough seizures after TLE surgery, and may alter the long‐term disease course in some patients.