Discontinuation of antiepileptic drugs after successful epilepsy surgery. A Canadian survey

Téllez‐Zenteno, José F.; Ronquillo, Lizbeth Hernández; Burneo, Jorge G.; Nguyen, Dang Khoa; Donner, Elizabeth; Sadler, Mark; M, Mano Javidan; Gross, Donald; Wiebe, Samuel

doi:10.1016/j.eplepsyres.2012.04.018

Cited by 43 publications

(42 citation statements)

References 10 publications

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“…These results are in general agreement with a previous survey of US epileptologists [9] and a recent survey of Canadian epileptologists [10]. In the former, 62% of the respondents said they waited >2 years of seizure freedom prior to tapering the last AED; 9% reported never tapering the last AED.…”

Section: Discussionsupporting

confidence: 82%

“…This study did not address when tapering of patients on multiple AEDs was initiated or how rapidly drugs were tapered. In the Canadian survey, for patients on multiple AEDs, 21% of the respondents started to reduce AEDs before 6 months and an additional 50% did so between 6 and 11 months [10]. Most of the respondents waited at least 2 years before tapering the last AED, although 21% reported doing so between 6 and 11 months.…”

Section: Discussionmentioning

confidence: 99%

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Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery

Swisher¹,

Sinha²

2013

Epilepsy & Behavior

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery

Swisher¹,

Sinha²

2013

Epilepsy & Behavior

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“…If correct, this hypothesis would limit the uncertainty about whether, when, and how to withdraw AEDs after successful surgery, and would actually be a welcome tool to confirm who was cured with surgery and who needs to continue medical therapy. In reality, however, despite all the knowledge and hypotheses summarized above, the clinical practice of postoperative AED management hasn't changed much over the past 2 decades (11,12). Why?…”

Section: Medication Management After Epilepsy Surgery: Opinions Versumentioning

confidence: 99%

Medication Management after Epilepsy Surgery: Opinions versus Facts

Jehi¹

2013

Epilepsy Curr

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CommentaryAntiepileptic drug (AED) discontinuation after surgery is a very polarizing issue. The driving forces on either end of the debate are obvious: discontinuing AEDs could eliminate unnecessary side effects, improve quality of life, and reduce cost, while maintaining AEDs could avoid potential risks of breakthrough seizures and their untoward consequences. Every epileptologist "believes" in an ideal candidate patient population, in a best time to initiate AED withdrawal-if at all-and in an optimal rate of medication tapering. Every "believer" can provide logical reasons supporting his/her stance. But, like every "belief, " the current practice of postoperative medication management is closer to faith and personal experience than it is to solid evidence. Multiple retrospective series are available (1-7), but few prospective studies have attempted to evaluate this issue, and both were observational (8, 9). In this "evidencescant" environment, what do we know?First, several retrospective studies suggest an increased rate of seizure-recurrence with earlier postoperative AED withdrawal (3, 6-7): when "earlier" was defined as less than 6 months (3) or 9 months (7) after surgery, the rate of seizure recurrence was an absolute 15 to 20 percent higher in the earlier withdrawal category. The article by Boshuisen et al. chosen for this commentary further quantifies this hazard to an additional 5% recurrence risk for every 3 months reduction in the time interval from surgery to the start of AED withdrawal. Yet, the two prospective series do not necessarily support this concern, as one found similar relapse rates between patients who continued their AEDs and those who reduced them either from two to one AED or from one to no AED (8). The other reported on the rates of seizure recurrence after AED taper initiated at 3 BACKGROUND: Postoperative antiepileptic drug (AED) withdrawal practices remain debatable and little is known about the optimum timing. We hypothesised that early AED withdrawal does not affect long-term seizure outcome but allows identification of incomplete surgical success earlier than late withdrawal. We aimed to assess the relation between timing of AED withdrawal and subsequent seizure recurrence and long-term seizure outcome. METHODS: TimeToStop included patients aged under 18 years from 15 centres in Europe who underwent surgery between Jan 1, 2000, and Oct 1, 2008, had at least 1 year of postoperative follow-up, and who started AED reduction after having reached postoperative seizure freedom. Time intervals from surgery to start of AED reduction (TTR) and complete discontinuation (TTD) were studied in relation to seizure recurrence during or after AED withdrawal, seizure freedom for at least 1 year, and cure (defined as being seizure free and off AEDs for at least 1 year) at latest follow-up. Cox proportional hazards regression models were adjusted for identified predictors of timing intervals. FINDINGS: TimeToStop included 766 children. Median TTR and TTD were 12·5 months (95% CI 11·9-13·2) and 28...

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“…Similarly, some studies suggest that early postoperative seizures predict eventual relapse of epilepsy (6), while others find no such predictive value (7). A recent survey found that the majority of epileptologists discontinue AEDs no earlier than a year of postoperative seizure freedom (2), although previous studies found no association between the timing of AED discontinuation and seizure relapse (3,5). Despite prospective trials of postoperative AED withdrawal after temporal lobectomy (4), there remains a large void in our knowledge of AED management after extratemporal lobe epilepsy (ETLE) surgery.…”

Section: Commentarymentioning

confidence: 99%

“…Discontinuation of AEDs, if possible, is desirable due to the cost, adverse events, and the continued stigma of the epilepsy label. Decisions regarding discontinuation or simplification of AED regimens in postsurgical patients are often influenced by patient preference (2) and uncertain clinical indicators that are largely inferred from retrospective studies. However, these studies may sometimes offer discordant conclusions; for example, some reports associate AED withdrawal with a higher risk of seizure relapse (3), while others find no such association (4,5).…”

Section: Commentarymentioning

confidence: 99%

Antiepileptic Medications after Extratemporal Epilepsy Surgery: When Do We Stop?

Koubeissi¹

2013

Epilepsy Curr

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Discontinuation of antiepileptic drugs after successful epilepsy surgery. A Canadian survey

Cited by 43 publications

References 10 publications

Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery

Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery

Medication Management after Epilepsy Surgery: Opinions versus Facts

Antiepileptic Medications after Extratemporal Epilepsy Surgery: When Do We Stop?

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