Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-05-10T10:49:50.775Z Has data issue: false hasContentIssue false
  • English
  • Français

Prognostic Tests and Antiepileptic Drug Withdrawal After Epilepsy Surgery

Published online by Cambridge University Press:  20 October 2014

Adil Harroud ,
Alexander G. Weil ,
Alain Bouthillier  and
Dang Khoa Nguyen
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.
*
Division of Neurology, Hôpital Notre-Dame du CHUM, 1560 rue Sherbrooke Est, Montreal, Quebec, H2L 4M1, Canada. Email: d.nguyen@umontreal.ca.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 4 , July 2014 , pp. 409 - 412
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Schmidt, D, Baumgartner, C, Loscher, W.Seizure recurrence after planned discontinuation of antiepileptic drugs in seizure-free patients after epilepsy surgery: a review of current clinical experience. Epilepsia. 2004;45(2):179–86.CrossRefGoogle ScholarPubMed
2.Berg, AT, Vickrey, BG, Langfitt, JT, et al. Reduction of AEDs in postsurgical patients who attain remission. Epilepsia. 2006;47(1):64–71.CrossRefGoogle ScholarPubMed
3.Shih, JJ, Ochoa, JG.A systematic review of antiepileptic drug initiation and withdrawal. Neurologist. 2009;15(3):122–31.CrossRefGoogle ScholarPubMed
4.Wilkins, DE.A guideline for discontinuing antiepileptic drugs in seizure-free patients. Neurology. 1999;53(1):239.CrossRefGoogle ScholarPubMed
5.Shinnar, S, Vining, EP, Mellits, ED, et al. Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. A prospective study. N Engl J Med. 1985;313(16):976–80.CrossRefGoogle ScholarPubMed
6.Lossius, MI, Hessen, E, Mowinckel, P, et al. Consequences of antiepileptic drug withdrawal: a randomized, double-blind study (Akershus Study). Epilepsia. 2008;49(3):455–63.CrossRefGoogle ScholarPubMed
7.Tellez-Zenteno, JF, Ronquillo, LH, Jette, N, et al. Discontinuation of antiepileptic drugs after successful epilepsy surgery. a Canadian survey. Epilepsy Res. 2012;102(1–2):23–33.CrossRefGoogle ScholarPubMed
8.Berg, AT, Langfitt, JT, Spencer, SS, Vickrey, BG.Stopping antiepileptic drugs after epilepsy surgery: a survey of U.S. epilepsy center neurologists. Epilepsy Behav. 2007;10(2):219–22.CrossRefGoogle ScholarPubMed
9.Rathore, C, Panda, S, Sarma, PS, Radhakrishnan, K.How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy? Epilepsia. 2011;52(3):627–35.CrossRefGoogle ScholarPubMed
10.Rathore, C, Sarma, SP, Radhakrishnan, K.Prognostic importance of serial postoperative EEGs after anterior temporal lobectomy. Neurology. 2011;76(22):1925–31.CrossRefGoogle ScholarPubMed
11.Murro, AM, King, DW, Smith, JR, et al. Withdrawal of antiepileptic medications following epilepsy surgery. J Epilepsy. 1991;4(1):39–42.CrossRefGoogle Scholar
12.Schiller, Y, Cascino, GD, So, EL, Marsh, WR.Discontinuation of antiepileptic drugs after successful epilepsy surgery. Neurology. 2000;54(2):346–9.CrossRefGoogle ScholarPubMed
13.Park, K-I, Lee, SK, Chu, K, et al. Withdrawal of antiepileptic drugs after neocortical epilepsy surgery. Ann Neurol. 2010;67(2):230–8.CrossRefGoogle ScholarPubMed
14.Lachhwani, DK, Loddenkemper, T, Holland, KD, et al. Discontinuation of medications after successful epilepsy surgery in children. Pediatr Neurol. 2008;38(5):340–4.CrossRefGoogle ScholarPubMed
15.Menon, R, Rathore, C, Sarma, SP, Radhakrishnan, K.Feasibility of antiepileptic drug withdrawal following extratemporal resective epilepsy surgery. Neurology. 2012;79(8):770–6.CrossRefGoogle ScholarPubMed
16.Jeha, LE, Najm, IM, Bingaman, WE, et al. Predictors of outcome after temporal lobectomy for the treatment of intractable epilepsy. Neurology. 2006;66(12):1938–40.CrossRefGoogle ScholarPubMed
17.Kim, YD, Heo, K, Park, SC, et al. Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. Epilepsia. 2005;46(2):251–7.CrossRefGoogle ScholarPubMed
18.Harroud, A, Weil, AG, Bouthillier, A, Nguyen, DK.Antiepileptic drugs withdrawal after successful epilepsy surgery: utility of postoperative EEG [abstract]. Epilepsia. 2013;54(Suppl. 3):69.Google Scholar
19.Schramm, J.Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia. 2008;49(8):1296–307.CrossRefGoogle ScholarPubMed