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Management of Antiepileptic Drugs following Epilepsy Surgery: A Review

Published online by Cambridge University Press:  02 December 2014

Richard S. McLachlan  and
John Maher
Richard S. McLachlan
Affiliation:
Department of Clinical Neurological Sciences, University of Western, Ontario, London, Canada
John Maher
Affiliation:
Department of Medicine, University of Manitoba, Winnipeg, Canada
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Abstract

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The favourable impact of surgery for intractable epilepsy on seizures is well documented. However, few studies have determined what changes in antiepileptic drug (AED) therapy occur following surgery. Alterations in AED blood levels in the immediate postoperative period can result in breakthrough seizures. In long term follow-up, one-third to one-half of seizure-free patients after temporal lobectomy, the most common type of epilepsy surgery, still require AED treatment which usually has been reduced from polytherapy to monotherapy. In our study of 93 patients followed two years after temporal lobectomy, polytherapy decreased from 78% before surgery to 14% postoperatively, while medication was discontinued in 44%. Early reduction from polytherapy to monotherapy can often be carried out in the immediate postoperative period but the most appropriate timing of cessation of AED treatment has yet to be determined. Patients undergoing extratemporal resections and other forms of epilepsy surgery associated with less favourable postoperative seizure control may achieve comparatively less reduction in antiepileptic medication. We generally do not recommend stopping AEDs prior to one year after surgery.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue S1: Canadian Temporal Lobe Epilepsy Surgery Workshop , May 2000 , pp. S106 - S110
Copyright
Copyright © The Canadian Journal of Neurological 2000

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