From Clinical Neurology News, 24 February 2014:
Withdrawing antiepileptic medication after temporal lobe epilepsy surgery may increase the risk of breakthrough seizures in the short term but does not alter long-term remission rates, a retrospective, observational cohort study found.
Two years after surgery, 69% of patients whose medication was discontinued at 1 year were completely seizure free, compared with 72% of those whose medication was reduced at 1 year and 79% of those whose medication was unchanged, Dr. Ruta Yardi of the Cleveland Clinic and her colleagues reported in Annals of Clinical and Translational Neurology (Ann. Clin. Transl. Neurol. 2014;1:115-23 [doi:10.1002/acn3.35]).
The authors said that there is long-standing debate on how to manage antiepilepsy medication after surgery, with concerns about breakthrough seizures being countered by patient desire to cease medication, concerns about polytherapy toxicity, and the rising cost of medication. There is little, however, by way of guidance on postoperative antiepileptic medication management.
“Our findings suggest though that postoperative AED [antiepileptic drug] management in this [temporal lobe epilepsy] cohort may reflect a compromise between needing to relieve patients from significant medication-related side effects and confidence about surgical success,” Dr. Yardi and her associates wrote. Read more.