Reduction of AEDs in postsurgical patients who attain remission.
OBJECTIVE
Little evidence guides practice regarding the reduction of antiepileptic drugs (AEDs) in individuals who achieve significant periods of remission after resective surgery.


METHODS
In a prospective study of 396 individuals who underwent resective surgery for intractable seizures, the impact of reducing AEDs on relapse and predictors of relapse were examined.


RESULTS
Of 301 study subjects who attained a 1-year seizure remission after surgery, 129 reduced from two to one or from one to no AEDs after achieving remission, and 162 did not reduce drugs. Ten patients who stopped all AEDs before attaining remission were excluded from analysis. In all, 114 (39%) patients relapsed: 73 (45%) of 162 in the nonreduction group and 41 (32%) of 129 in the reduction group (p = 0.02). Patients who reduced drugs were more likely to have remitted immediately after hospital discharge (p<0.0001). After adjustment for this factor, little or no apparent impact of drug reduction on the rate of relapse was noted [rate ratio (RR), 1.1; 95% CI, 0.72-1.71; p=0.64 for reducing from two to one AED, and RR, 0.85; 95% CI, 0.50-1.45; p=0.56 for reducing from one to no AEDs]. Within the 129 patients who reduced AEDs, only delayed remission after hospital discharge was significantly associated with an increased rate of relapse (RR, 2.26; 95% CI, 1.15- 4.48; p=0.02). Continued auras had a marginally significant association with relapse (RR, 2.06; p=0.07)


CONCLUSIONS
Although many relapses in this cohort of postsurgical patients who achieved remission occurred in the context of reducing or completely eliminating AEDs, the risk was no higher than in those who continued AEDs. Randomized studies are needed to test the impact of drug reduction in seizure-free postsurgical patients.
Berg
Anne T
AT
BIOS, NIU, DeKalb, Illinois 60115, USA. atberg@niu.edu
Vickrey
Barbara G
BG
Langfitt
John T
JT
Sperling
Michael R
MR
Shinnar
Shlomo
S
Bazil
Carl
C
Walczak
Thaddeus
T
Spencer
Susan S
SS
D000328:Adult; D038481:Anterior Temporal Lobectomy; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy* / Q000601:surgery*; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016019:Survival Analysis; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants