Management of Antiepileptic Treatment After Epilepsy Surgery - Practices and Problems

Title:Management of Antiepileptic Treatment After Epilepsy Surgery - Practices and Problems

Volume: 23 Issue: 37

Author(s): Guido Rubboli*, Anne Sabers, Peter Uldall and Kristina Malmgren

Affiliation:

• Danish Epilepsy Center, Filadelfia/University of Copenhagen, Dianalund,Denmark

Keywords: Epilepsy surgery, drug resistance, AED, AED withdrawal, AED tapering, seizure relapse, seizure outcome.

Abstract: Background: Although epilepsy surgery is a recognized treatment option for drug-resistant epilepsies since several decades, the management of antiepileptic drugs (AEDs) after successful surgery still remains one of the most difficult and unsolved therapeutic challenges. Indeed, no systematic controlled trials have been specifically conducted so far and no consensus or standardized guidelines regarding postsurgical drug discontinuation policy and procedures are available.

Methods: In this paper, we aim to provide an updated overview on the present knowledge on this topic, which is based mainly on retrospective studies reporting practices used in individual centers.

Results: Currently available data suggest that: 1) rate of seizure recurrence appears to be higher in patients undergoing early (before 6 months or 9 months according to different studies) AED withdrawal; 2) seizures that recur during AED tapering are easier to control than unprovoked postoperative seizure relapses; 3) there is no evidence to support negative long-term implications on seizure outcomes in patients who attempted AED withdrawal. In the pediatric age group, shorter intervals from surgery to AED reduction and to complete AED discontinuation predict seizure relapse during or after AED reduction/withdrawal. However, this does not correlate with the chances of regaining seizure freedom after drug reintroduction.

Conclusion: Carefully conducted prospective longitudinal studies and randomized controlled trials are warranted to establish the correct post-surgical pharmacologic treatment and to identify the best candidates for AEDs discontinuation.

Cite this article as:

Rubboli Guido*, Sabers Anne, Uldall Peter and Malmgren Kristina, Management of Antiepileptic Treatment After Epilepsy Surgery - Practices and Problems, Current Pharmaceutical Design 2017; 23 (37) . https://dx.doi.org/10.2174/1381612823666170823111712

DOI https://dx.doi.org/10.2174/1381612823666170823111712	Print ISSN 1381-6128
Publisher Name Bentham Science Publisher	Online ISSN 1873-4286