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Abstract
Objective To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy.
Methods We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug.
Results Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7–17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2%) on attempted withdrawal. After a median postrecurrence follow-up of 7 years, 79 (86%) of them were seizure-free during the terminal 2 years. AEDs could be stopped in 17 patients (18.5%) and doses were reduced in another 57 patients (62%). Patients with febrile seizures, normal postoperative EEG at 1 year, and duration of epilepsy of <20 years (FND20 score) had 17% risk of seizure recurrence on attempted AED withdrawal. We also formulated a score to predict the chances of AED freedom for the whole cohort.
Conclusion Patients with seizure recurrence on AED withdrawal have good outcome with 86% becoming seizure-free and 18% becoming drug-free after initial recurrence. A FND20 score helps in predicting recurrence on AED withdrawal.
Glossary
- AED=
- antiepileptic drug;
- ATL=
- anterior temporal lobectomy;
- CI=
- confidence interval;
- FND20 score=
- febrile seizures, normal EEG at 1 year, duration of epilepsy less than 20 years;
- HS=
- hippocampal sclerosis;
- IED=
- interictal epileptiform discharge;
- MTLE=
- mesial temporal lobe epilepsy;
- MTS=
- mesial temporal sclerosis;
- No-FUNDS score=
- no febrile seizures, no unilateral interictal epileptiform discharges, no normal postoperative EEG, no duration less than 20 years, and no sclerosis on MRI;
- OR=
- odds ratio
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received November 17, 2017.
- Accepted in final form April 10, 2018.
- © 2018 American Academy of Neurology
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