Drug withdrawal after successful epilepsy surgery: how safe is it?
Discontinuation of antiepileptic drugs (AEDs) is one reason patients undergo epilepsy surgery, but little is known about the risk of seizure recurrence. We describe a prospective pilot study of withdrawal performed at our epilepsy center. Sixty completely seizure-free patients were included between 1997 and 2003. AED withdrawal was proposed 1 year after surgery after a detailed discussion of the risks and benefits. On the basis of their decision on withdrawal, patients were stratified into two cohorts (withdrawal group, N=34; control group, N=26). Discontinuation was carried out in small tapering steps over 1 year with yearly follow-up visits. Withdrawal was stopped when seizures recurred or the patients objected to further discontinuation. Twenty-six of 34 (76.5%) persons in the withdrawal group and 16 of 26 (61.5%) persons in the control group were seizure free 5 years after surgery. In this study, AED discontinuation 1 year after successful epilepsy surgery was not associated with a risk of seizure recurrence higher than that of controls.
Kerling
Frank
F
Epilepsy Center (ZEE), Department of Neurology, University Hospital of Erlangen, Schwabachanlage 6, Erlangen, Germany. frank.kerling@uk-erlangen.de
Pauli
Elisabeth
E
Lorber
Bogdan
B
Blümcke
Ingmar
I
Buchfelder
Michael
M
Stefan
Hermann
H
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000517:prevention & control; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants