Medication management after epilepsy surgery: Are we closer to an answer?

摘要

Persons with intractable epilepsy undergo resective brain surgery with the twin goals of seizure freedom and simplification of complicated preoperative anti-epileptic drug (AED) regimens. The humbling truth remains, however, that there are no guidelines rationally steering physician and patient decision-making on drug withdrawal after epilepsy surgeries. The available knowledge is based on retrospective series describing individual centers' experience, 2 prospective cohort studies reporting on AED withdrawal following temporal lobe surgery, but without prospective data following extratemporal resections. Solid conclusions remain elusive with reported rates of successful AED discontinuation varying from 27% to 80%, rates of seizure recurrence during attempted AED withdrawal ranging from 25% to 47%, and median times for initiation of medication changes ranging from few months to more than a year.