Surgery for drug-resistant epilepsy is performed with the dual aim of obtaining seizure freedom and potential for reducing or discontinuing anticonvulsant drugs (AEDs). Most epilepsy patients become seizure free with surgery. But there are no criteria for the timing of AED withdrawal following the procedure, and the long-term effect of post-operative AED withdrawal is unclear.
In a report presented at the American Epilepsy Society 67th Annual Meeting, researchers at the Cleveland Clinic investigated the implications of AED withdrawal following surgery for drug-resistant temporal lobe epilepsy (TLE). The team reviewed all TLE patients in their clinic with a post-operative follow up of at least six months and ranging up to 16.7 years. More than 600 patients met the study criteria, including a patient cohort whose medication was withdrawn and a second cohort, used as the control, whose medication remained unchanged after surgery.
The investigators assessed the long-term recurrence of seizures following early and late withdrawal of AEDs post-surgery, and compared that with seizure recurrence when AEDs remained unchanged following the procedure.
"We found that the seizure recurrence rate was higher with an early change in AED than with a late change in medications, which is consistent with what is suggested in the literature," says Ruta Yardi, M.D., who presented the report. "However, in comparing the cohort with reduced or discontinued AED therapy to the cohort where AEDs were unchanged, there was no difference in long-term seizure freedom, regardless of what might have caused the temporal lobe epilepsy."
The investigators point out that the results of their large retrospective controlled cohort study need to be further evaluated in a well-designed prospective randomized trial.
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