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Management of Antiepileptic Drugs following Epilepsy Surgery: A Review

Published online by Cambridge University Press:  02 December 2014

Richard S. McLachlan  and
John Maher
Richard S. McLachlan
Affiliation:
Department of Clinical Neurological Sciences, University of Western, Ontario, London, Canada
John Maher
Affiliation:
Department of Medicine, University of Manitoba, Winnipeg, Canada
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Abstract

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The favourable impact of surgery for intractable epilepsy on seizures is well documented. However, few studies have determined what changes in antiepileptic drug (AED) therapy occur following surgery. Alterations in AED blood levels in the immediate postoperative period can result in breakthrough seizures. In long term follow-up, one-third to one-half of seizure-free patients after temporal lobectomy, the most common type of epilepsy surgery, still require AED treatment which usually has been reduced from polytherapy to monotherapy. In our study of 93 patients followed two years after temporal lobectomy, polytherapy decreased from 78% before surgery to 14% postoperatively, while medication was discontinued in 44%. Early reduction from polytherapy to monotherapy can often be carried out in the immediate postoperative period but the most appropriate timing of cessation of AED treatment has yet to be determined. Patients undergoing extratemporal resections and other forms of epilepsy surgery associated with less favourable postoperative seizure control may achieve comparatively less reduction in antiepileptic medication. We generally do not recommend stopping AEDs prior to one year after surgery.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue S1: Canadian Temporal Lobe Epilepsy Surgery Workshop , May 2000 , pp. S106 - S110
Copyright
Copyright © The Canadian Journal of Neurological 2000

References

1. Engel, J, Van Ness, PC, Rasmussen, TB, Ojemann, LM. Outcome with respect to epileptic seizures. In: Engel, J, ed. Surgical Treatment of the Epilepsies. 2nd ed. New York: Raven Press, 1993; 609–621.Google ScholarPubMed
2. McLachlan, RS, Rose, K, Derry, PA, et al. Health-related quality of life and seizure control in TLE: a prospective comparison of surgical and medical management. Ann Neurol 1997; 41:482–489.CrossRefGoogle Scholar
3. Vickrey, BG, et al. Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery. Lancet 1995; 346:1445–1449.CrossRefGoogle ScholarPubMed
4. Wingkun, ED, Awad, IA, Luders, H, Awad, CA. Natural history of recurrent seizures after resective surgery for epilepsy. Epilepsia 1991; 32:851–856.CrossRefGoogle ScholarPubMed
5. McLachlan, RS. Medical management of epilepsy and theoretical basis for surgical therapy. In: Varkey, GP, ed. Anesthetic Considerations for Craniotomy in Awake Patients. Boston: Little Brown, 1986:31–45.Google Scholar
6. Ojemann, GA, Bourgeois, BF. Early postoperative management. In: Engel, J, ed. Surgical Treatment of the Epilepsies. 2nd ed. New York: Raven Press, 1993:539–540.Google Scholar
7. Cruz-Rodriguez, RF, Graves, NM, Leppik, IE, Wilder, R. Carbamazepine toxicity after epilepsy surgery. Epilepsia 1989; 30:640.Google Scholar
8. Gidal, BE, Spencer, NW, Maly, MM, Pitterle, ME. Evaluation of carbamazepine and carbamazepine-epoxide protein binding in patients undergoing epilepsy surgery. Epilepsia 1996; 37:381–385.CrossRefGoogle ScholarPubMed
9. Duncan, JS, Shorvon, SD, Fish, DR. Clinical Epilepsy. New York. Churchill Livingstone, 1995:224–228.Google Scholar
10. Chadwick, D, Reynolds, EH. When do epileptic patients need treatment? Starting and stopping medications. Br Med J 1985; 290:1885–1888.CrossRefGoogle Scholar
11. Callaghan, N, Garrett, A, Goggin, T. Withdrawal of anticonvulsant drugs in patients free of seizures for two years. N Engl J Med 1988; 318:942–946.CrossRefGoogle ScholarPubMed
12. Andermann, F, Bourgeois, BF, Leppik, IE, Ojemann, LM, Sherwin, AL. Postoperative pharmacotherapy and discontinuation of antiepileptic drugs. In: Engel, J, ed. Surgical Treatment of the Epilepsies. 2nd ed. New York: Raven Press, 1993:679–684.Google Scholar
13. Tuunainen, A, Nousiainen, U, Mervaala, E, et al. Postoperative EEG and electrocorticography: relation to clinical outcome in patients with temporal lobe surgery. Epilepsia 1994; 35:1165–1173.CrossRefGoogle ScholarPubMed
14. Godoy, J, Lüders, H, Dinner, DS, et al. Significance of sharp waves in routine EEGs after epilepsy surgery. Epilepsia 1992; 33:285–288.CrossRefGoogle ScholarPubMed
15. So, N, Olivier, A, Andermann, F, Gloor, P, Quesney, LF. Results of surgical treatment in patients with bitemporal epileptiform abnormalities. Ann Neurol 1989; 25:432–439.CrossRefGoogle ScholarPubMed
16. Kanazawa, O, Blume, WT, Girvin, JP. Significance of spikes at temporal lobe electroencephalography. Epilepsia 1996; 37:50–55.CrossRefGoogle Scholar
17. Deckers, CLP, Hekster, YA, Keyser, A, Meinardi, H,Renier, WO. Reappraisal of polytherapy in epilepsy: a critical review of drug load and adverse effects. Epilepsia 1997; 38:570–575.CrossRefGoogle ScholarPubMed
18. Reynolds, EH, Shorvon, SD. Monotherapy or polytherapy for epilepsy. Epilepsia 1981; 22:1–10.CrossRefGoogle ScholarPubMed
19. Albright, P, Bruni, J. Reduction of polytherapy in epileptic patients. Arch Neurol 1982; 23:531–544.Google Scholar
20. Schmidt, D. Reduction of two-drug therapy in intractable epilepsy. Epilepsia 1983; 24:368–376.CrossRefGoogle ScholarPubMed
21. Thompson, PJ, Trimble, MR. Anticonvulsant drugs and cognitive functions. Epilepsia 1982; 23:531–544.CrossRefGoogle ScholarPubMed
22. Wieser, HG. Selective amygdalohippocampectomy for temporal lobe epilepsy. Epilepsia 1988; 29 :S100-S113.CrossRefGoogle ScholarPubMed
23. Guldvog, B, Loyning, Y, Hauglie-Hanssen, E, Flood, S, Bjornaes, H. Surgical treatment for partial epilepsy among Norwegian adults. Epilepsia 1994; 35:540–553.CrossRefGoogle ScholarPubMed
24. Gilliam, F, et al. Epilepsy surgery outcome: comprehensive assessment in children. Neurology 1997; 48:1368–1374.CrossRefGoogle ScholarPubMed
25. Maher, J, McLachlan, RS. Antiepileptic drug treatment following temporal lobectomy. Neurology 1998; 51:305–307.CrossRefGoogle ScholarPubMed
26. Kuzniecky, R, Rubin, ZK, Faught, E, Morawetz, R. Antiepileptic drug treatment after temporal lobe epilepsy surgery: a randomized study comparing carbamazepine and polytherapy. Epilepsia 1992; 33:908–912.CrossRefGoogle ScholarPubMed
27. Schmidt, D. Adverse effects. In: Frey, H, Janz, D, eds. Antiepileptic Drugs: Handbook of Experimental Pharmacology. Berlin: Springer-Verlag, 1985:791–829.CrossRefGoogle Scholar
28. Krahn, Le, Rummans, TA, Sharbrough, FW, Jowsey, SG, Cascino, GD. Pseudoseizures after epilepsy surgery. Psychosomatics 1995; 36:487–493.CrossRefGoogle ScholarPubMed
29. Greenberg, MK, et al. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients-summary statement. Neurology 1996; 47:600–602.Google Scholar
30. Schmidt, D, Gram, L. A practical guide to when (and how) to withdraw antiepileptic drugs in seizure-free patients. Drugs 1996; 52:870–874.CrossRefGoogle ScholarPubMed