WASHINGTON – Antiepileptic drug reduction should be considered in children who are seizure free after epilepsy surgery, according to findings from a retrospective chart study.
Patients in the study who withdrew from antiepileptic drug (AED) treatment were not significantly more likely to have seizure recurrence than were those who did not, thereby meeting the common secondary goal of discontinuing or reducing AEDs after epilepsy surgery. Thus, the findings of this study may provide reassurance to neurologists who are hesitant to withdraw AEDs after surgery because of concerns that seizures may recur, Dr. Katherine C. Nickels of the Mayo Clinic, Rochester, Minn., reported in a poster at the annual meeting of the American Epilepsy Society.
Of 79 children who underwent resective surgery for intractable epilepsy between 2008 and 2012 and who were followed for a mean of 33.6 months, 50 were seizure free at 3 months, and 49 of those children were treated with antiepileptic drugs. At last follow-up, 37 (76%) were seizure free, including 24 of 28 (86%) in whom AEDs were reduced, and 13 of 21 (62%) in whom AEDs were not reduced, the researchers found.
The study involved children from birth through age 17 years who underwent surgery at the Mayo Clinic. A medical chart review was conducted to determine whether patients were seizure free 3 months after surgery, and to determine the number of medical and nonmedical therapies tried before and at the time of surgery, when therapies were reduced after surgery (if at all), the number of medications and therapies used at last follow-up, and seizure outcomes based on Engel classification at 3, 6, 12, 24, and 36 months, and at final follow-up after surgery.
Seizure recurrence was not found to be associated with abnormal findings on MRI, type and location of resection, or underlying pathology.
AED reduction was not a significant risk factor for seizure recurrence, regardless of when AED reduction occurred, Dr. Nickels noted. The median time to recurrence was 9 months after surgery, regardless of whether AEDs were reduced.
The AES meeting did not require reports of financial disclosures.