Back to Search Start Over

Early antiseizure medication withdrawal and risk of seizure recurrence in children after epilepsy surgery: A retrospective study.

Authors :
Wu, YuXin
Zhang, ZaiYu
Liang, Ping
Zou, Bin
Wang, Difei
Wu, XuanXuan
Zhai, Xuan
Source :
Epilepsy & Behavior. Jan2024, Vol. 150, pN.PAG-N.PAG. 1p.
Publication Year :
2024

Abstract

• According to the American Academy of Neurology guidelines, for children seizure-free for 18–24 months post-epilepsy surgery, a discussion on the risks and benefits of ASM withdrawal is recommended. • We attempted early withdrawal of antiseizure medications in 99 children who were seizure free after resection surgery and the most obvious finding to emerge from this study is that early ASM withdrawal is relatively viable and safe. • Approximately one in five children experienced seizure recurrence during or after ASM withdrawal and 60% of patients with recurrent seizure immediately returned to seizure free after restart and optimized ASM. • Incomplete resection and postoperative seizures prior to ASM withdrawal are independent predictors of seizure recurrence. The timing of antiseizure medication (ASM) withdrawal in children after epilepsy surgery remains controversial and lacks recognized standards. Given the various negative effects of ASM on development in children, this study aimed to evaluate the safety and feasibility of early ASM withdrawal after epileptic resection surgery. We retrospectively assessed the seizure outcomes and ASM profiles of children who had undergone epileptic resection surgery between August 2015 and August 2020 and attempted ASM reduction in the early postoperative phase. Tapering the dose of ASM was attempted when children were seizure-free with no interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) for at least 6 months postoperatively. This study included 145 children with a median follow-up duration of 40 months. Early ASM tapering was attempted postoperatively in 99 (68.3 %) children. Postoperative ASM discontinuation was attempted in 87 (60.0 %) children. Nine (9.1 %) children experienced seizure recurrence during the ASM reduction stage, and 10 (11.5 %) experienced recurrence after ASM discontinuation. Incomplete resection (P = 0.003) and postoperative seizures before ASM tapering (P = 0.003) were independent predictors of seizure recurrence during and after early ASM withdrawal. ASM withdrawal is viable and safe to be initiated in children who are seizure-free postoperatively and have no IEDs on the scalp EEG for at least 6 months. Children with incomplete resection and postoperative seizures before ASM withdrawal are at a higher risk of seizure recurrence and may need to continue ASM for a longer period. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
15255050
Volume :
150
Database :
Academic Search Index
Journal :
Epilepsy & Behavior
Publication Type :
Academic Journal
Accession number :
174709494
Full Text :
https://doi.org/10.1016/j.yebeh.2023.109556