John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the International League Against Epilepsy

Discontinuation of antiepileptic drugs after successful surgery: who and when? Volume 14, numéro 4, December 2012

Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  • Mots-clés : epilepsy, discontinuation, withdrawal, AED, successful epilepsy surgery
  • DOI : 10.1684/epd.2012.0538
  • Page(s) : 363-70
  • Année de parution : 2012

Surgery is a highly effective treatment for some specific types of refractory epilepsy and once seizure freedom is achieved many patients and clinicians have to ponder whether to taper or discontinue antiepileptic drugs (AEDs). However, there is no standard practice or guidelines and practices vary widely. The few studies that have addressed this question are retrospective and lack randomised, controlled comparisons, making it difficult to draw any solid inferences. This review examines this topic by analysing key data based on the following: controlled studies which compare outcomes in patients with either withdrawn or unmodified AEDs after epilepsy surgery, non-controlled studies, information from meta-analyses and systematic reviews, surveys of clinical practice, and other relevant reviews. Between 12 and 32% of patients had seizure relapse following tapering or discontinuation of AEDs, which was not significantly different from 7 to 45% in patients without AED modification. In the event of seizure relapse upon tapering of AEDs, 45-92.3% restarted AED treatment and regained seizure freedom. The most consistent risk factors for seizure relapse were: age older than 30 years at the time of surgery, persistent auras, early drug tapering, seizure recurrence before a reduction of drugs, normal MRI, a longer period with epilepsy, absence of hippocampal sclerosis, and the presence of interictal discharges on EEG after surgery.