Factors related to successful antiepileptic drug withdrawal after anterior temporal lobectomy for medial temporal lobe epilepsy.
OBJECTIVE
To assess the rate of successful antiepileptic drug (AED) discontinuation, prognostic factors and proper time of AED withdrawal after surgery for medial temporal lobe epilepsy (MTLE).


METHODS
We reviewed 171 consecutive patients who underwent resective surgery for MTLE. All patients were followed up for more than two postoperative years. AEDs were slowly tapered with an individualized schedule for each patient. Outcome status was determined from medical records and telephone interviews.


RESULTS
41.2% of patients experienced no seizure recurrence. 34.5% discontinued medication without seizure recurrence for more than 2 years at final assessment. Multivariate analysis revealed that an age greater than 30 years at surgery and postoperative AED reduction before 10 months increased the risk of recurrence [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.1-3.9 and HR 2.5, CI 1.1-5.8].


CONCLUSIONS
Resective surgery for MTLE brings seizure remission without AED to one-third of patients. Postoperative AED tapering is recommended after at least 10 months. Younger age at surgery is a good predictive factor of remission after MTLE surgery.
Lee
Seo-Young
SY
Department of Neurology, Kangwon National University, Republic of Korea.
Lee
Ji-Young
JY
Kim
Dong Wook
DW
Lee
Sang Kun
SK
Chung
Chun Kee
CK
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D038481:Anterior Temporal Lobectomy; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D003625:Data Collection; D004827:Epilepsy / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000927:Anticonvulsants