Antiepileptic drugs ‘can be safely discontinued following successful surgery’

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New research has underlined the safety of discontinuing treatment with antiepileptic drugs (AEDs) among patients who have successfully undergone epilepsy surgery.

Carried out by researchers at the University of Saskatchewan in Canada, the meta-analysis aimed to establish a consensus regarding the management of AEDs after successful epilepsy surgery, as none previously existed.

Collating the most relevant evidence in this topic, the team identified 257 abstracts and eventually selected 16 papers for consideration, describing outcomes in 1,456 patients who discontinued AEDs and 685 patients who did not.

Results published in the medical journal Epilepsy Research revealed that the odds of experiencing seizure recurrence after AED discontinuation was 0.39 times lower in patients who ceased treatment after undergoing surgery.

A minority of patients who were seizure-free after surgery had recurrence after discontinuation, but recurrence tended to be higher for those without AED withdrawal.

It was also noted that patients who did experience seizure recurrence after discontinuation found the problem relatively easy to bring back under control after restarting their programme of medication.

Differences in the success of this strategy were attributed to specific attributes of the selected population where discontinuation was attempted, with young patients with lesional temporal epilepsy shown to be good candidates. This suggests that doctors need to be selective when choosing when to apply this principle.

The researchers concluded: “The discontinuation of medications should be done in good candidates and the decision should be individualised taking into account clinical, electrographical, imaging and histopathological variables.”

Around two thirds of epileptic seizures can be successfully treated and controlled through the appropriate use of AEDs, though they do not help every patient in the long term. For those who are unable to benefit from drug therapy, surgery can be a preferable option.

Surgical interventions can be performed on both adults and children and are utilised when a physical cause for the epilepsy can be found in a specific area of the brain.

Posted by Bob Jones