Study Suggests Post-Operative Change in AED Therapy May Not Necessarily Affect Long-term Seizure Outcome after Temporal Lobe Surgery

Article ID: 610532

Released: 18-Nov-2013 4:50 PM EST

Source Newsroom: American Epilepsy Society (AES)

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Newswise — Washington, DC, December 7, 2013 - Surgery for drug–resistant epilepsy is performed with the dual aim of obtaining seizure freedom and potential for reducing or discontinuing anticonvulsant drugs (AEDs). Most epilepsy patients become seizure free with surgery. But there are no criteria for the timing of AED withdrawal following the procedure, and the long-term effect of post-operative AED withdrawal is unclear.

In a report presented at the American Epilepsy Society 67th Annual Meeting, researchers at the Cleveland Clinic investigated the implications of AED withdrawal following surgery for drug-resistant temporal lobe epilepsy (TLE). The team reviewed all TLE patients in their clinic with a post-operative follow up of at least six months and ranging up to 16.7 years. More than 600 patients met the study criteria, including a patient cohort whose medication was withdrawn and a second cohort, used as the control, whose medication remained unchanged after surgery. (Platform B.08/abstract 1750581 – Antiepileptic Drug Withdrawal and Long-term Epilepsy Recurrence after Surgery. )

The investigators assessed the long-term recurrence of seizures following early and late withdrawal of AEDs post-surgery, and compared that with seizure recurrence when AEDs remained unchanged following the procedure.

“We found that the seizure recurrence rate was higher with an early change in AED than with a late change in medications, which is consistent with what is suggested in the literature,” says Ruta Yardi, M.D., who presented the report. “However, in comparing the cohort with reduced or discontinued AED therapy to the cohort where AEDs were unchanged, there was no difference in long-term seizure freedom, regardless of what might have caused the temporal lobe epilepsy.”

The investigators point out that the results of their large retrospective controlled cohort study need to be further evaluated in a well-designed prospective randomized trial.

Authors:Ruta Yardi, MD; Anna Irwin, MD: Husam Kayyall, MD; Ajay Gupta, MD; Dileep Nair, MD; Jorge Gonzalez-Martinez, MD, PhD; William Bingaman, MD; Imad M. Najm, MD; Lara E. Jehi, MD.

Editors Note: Authors of this study will be available at a press briefing at 10:45 am (EDT), December 7, in the onsite pressroom, Room 209-A, Level 2 of the Walter E. Washington Convention Center. The call-in number for off-site journalists is 1-605-475-4000, passcode 521653#.

About EpilepsyThe epilepsies affect 50 million people worldwide, including three million in the United States. The disorder can have a single specific, well-defined cause, such as a head injury, or manifest as a syndrome with a complex of symptoms. It is the third most common neurological disorder after Alzheimer’s disease and stroke.

About the American Epilepsy Society (AES)The American Epilepsy Society, based in West Hartford, CT, seeks to advance and improve the treatment of epilepsy through the promotion of epilepsy research and education for healthcare professionals. The Society’s annual meeting is the largest scientific meeting in epilepsy and each year attracts some 4,000 physicians, scientists and allied healthcare professionals from around the world.

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