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Prognostic Tests and Antiepileptic Drug Withdrawal After Epilepsy Surgery

Published online by Cambridge University Press:  20 October 2014


Adil Harroud
Affiliation:
Division of Neurology, Hôpital Notre-Dame du CHUM, Université de Montréal, Montreal, Quebec, Canada.
Alexander G. Weil
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, Université de Montréal, Montreal, Quebec, Canada.
Alain Bouthillier
Affiliation:
Division of Neurosurgery, Hôpital Notre-Dame du CHUM, Université de Montréal, Montreal, Quebec, Canada.
Dang Khoa Nguyen
Affiliation:
Division of Neurology, Hôpital Notre-Dame du CHUM, Université de Montréal, Montreal, Quebec, Canada.
Corresponding
E-mail address:

Abstract

Approximately one in three patients with a successful epilepsy surgery will have seizure recurrence following antiepileptic drugs (AED) withdrawal. The value of postoperative testing for predicting seizure relapse after AED tapering is not clear. The purpose of this study was to review the literature for evidence on the use of postoperative investigations before AED discontinuation after successful epilepsy surgery. We were unable to identify studies on the prognostic value of postoperative magnetic resonance imaging and AED blood levels. The literature review yielded seven studies on the predictive value of electroencephalography. Four studies found no association between interictal discharges (IED) and seizure relapse. These studies suffered from various limitations due to their retrospective design and generally small cohorts. Two of the three studies reporting a positive association were prospective and provided strong evidence of an increased risk of seizure recurrence with presence of postoperative IED in successfully operated patients undergoing AED withdrawal.


Type
Review Article
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

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