Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy

Dae Kim Young, Kyoung Heo, Chul Park Soo, Kyoon Huh, JinWoo Chang, Uhn Choi Joong, Sup Chap Sang, In Lee Byung

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period. Results: Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.

Original languageEnglish
Pages (from-to)251-257
Number of pages7
JournalEpilepsia
Volume46
Issue number2
DOIs
Publication statusPublished - 2005 Feb 1

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Temporal Lobe Epilepsy
Anticonvulsants
Seizures
Drug Resistant Epilepsy
Recurrence
Epilepsy

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Young, Dae Kim ; Heo, Kyoung ; Soo, Chul Park ; Huh, Kyoon ; Chang, JinWoo ; Joong, Uhn Choi ; Sang, Sup Chap ; Byung, In Lee. / Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. In: Epilepsia. 2005 ; Vol. 46, No. 2. pp. 251-257.
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abstract = "Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period. Results: Sixty-six (75{\%}) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91{\%}) of 66 patients with a successful outcome. In 13 (22{\%}) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12{\%}) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45{\%}) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86{\%} vs. 23{\%}). At the final assessment, 54 (61{\%}) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.",
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Young, DK, Heo, K, Soo, CP, Huh, K, Chang, J, Joong, UC, Sang, SC & Byung, IL 2005, 'Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy', Epilepsia, vol. 46, no. 2, pp. 251-257. https://doi.org/10.1111/j.0013-9580.2005.28004.x

Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. / Young, Dae Kim; Heo, Kyoung; Soo, Chul Park; Huh, Kyoon; Chang, JinWoo; Joong, Uhn Choi; Sang, Sup Chap; Byung, In Lee.

In: Epilepsia, Vol. 46, No. 2, 01.02.2005, p. 251-257.

Research output: Contribution to journalArticle

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T1 - Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy

AU - Young, Dae Kim

AU - Heo, Kyoung

AU - Soo, Chul Park

AU - Huh, Kyoon

AU - Chang, JinWoo

AU - Joong, Uhn Choi

AU - Sang, Sup Chap

AU - Byung, In Lee

PY - 2005/2/1

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N2 - Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period. Results: Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.

AB - Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period. Results: Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.

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