title: Discontinuation of medications after successful epilepsy surgery in children.
abstract: To evaluate the need for antiepileptic drugs after successful epilepsy surgery in pediatric patients, we retrospectively reviewed patients who had epilepsy surgery and were seizure free or had rare nondisabling auras during the first 6 postoperative months. Association between drug discontinuation and seizure recurrence was evaluated using Cox proportional hazards multivariable survival analysis. Medications were withdrawn in 68 of 97 patients, seizure free (or with rare nondisabling auras) for >6 months after surgery; 57 of the 68 (84%) remained seizure free; the other 11 (16%) had seizure recurrence after 68 months (median). Seizure recurrence was controlled with medication in 7 of the 11 patients (3 have rare seizures, 1 frequent auras). Discontinuing medications at <6 mo, compared with later or no withdrawal, had significant risk for seizure recurrence (hazard ratio 5.8; 95% confidence interval 1.8, 17.5; P = 0.003). Of 29 patients who continued drugs, 28 (97%) remained seizure free after 37 months (median). Freedom from seizures 6 months after surgery predicted good outcome (95% seizure free, with or without medication). If discontinuation is offered after 6 months, the majority of patients (84%) can be expected to remain seizure free with no further need for medication. Although seizure breakthrough is possible in a smaller percentage, restarting drugs is likely to restore seizure control.
authors.affiliation: Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. lachhwd@ccf.org
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Lachhwani
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Holland
authors.forename: Prakash
authors.initials: P
authors.lastname: Kotagal
authors.forename: Edward
authors.initials: E
authors.lastname: Mascha
authors.forename: William
authors.initials: W
authors.lastname: Bingaman
authors.forename: Elaine
authors.initials: E
authors.lastname: Wyllie
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000139:chemically induced / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants