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

Summary Introduction To identify the perceived practice among Canadian epileptologists regarding discontinuation of antiepileptic drugs (AEDs) following successful resective surgery for temporal and extratemporal surgery. Methods We performed a survey of pediatric and adult epileptologists in Canada...

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Bibliographic Details
Published in:	Epilepsy research 2012-11, Vol.102 (1), p.23-33
Main Authors:	Téllez-Zenteno, José F, Ronquillo, Lizbeth Hernández, Jette, Nathalie, Burneo, Jorge G, Nguyen, Dang Khoa, Donner, Elizabeth J, Sadler, Mark, Javidan M, Mano, Gross, Donald W, Wiebe, Samuel
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Anticonvulsants - therapeutic use Anticonvulsants. Antiepileptics. Antiparkinson agents Antiepileptic drugs Biological and medical sciences Canada Child Electroencephalography Epilepsy surgery Epilepsy, Temporal Lobe - diagnosis Epilepsy, Temporal Lobe - drug therapy Epilepsy, Temporal Lobe - surgery Female Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Male Medical sciences Nervous system (semeiology, syndromes) Neurology Neurology - statistics & numerical data Neuropharmacology Pharmacology. Drug treatments Postoperative Complications - diagnosis Postoperative Complications - drug therapy Practice Patterns, Physicians' - statistics & numerical data Remission Induction Substance Withdrawal Syndrome - diagnosis Substance Withdrawal Syndrome - prevention & control Surgical outcomes Survey Surveys and Questionnaires Young Adult
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Summary:	Summary Introduction To identify the perceived practice among Canadian epileptologists regarding discontinuation of antiepileptic drugs (AEDs) following successful resective surgery for temporal and extratemporal surgery. Methods We performed a survey of pediatric and adult epileptologists in Canada, using a 77-item questionnaire to explore attitudes, timing, rate of withdrawal, and factors contributing to the decision to withdraw AEDs after successful epilepsy surgery. Surveys were mailed with a postage-paid return envelope. Two subsequent surveys were mailed to non-respondents at 15 days intervals. All procedures received institutional review board approval. Results Surveys were sent to 82 epileptologists in all the Canadian provinces. Sixty-six physicians answered the survey (80.5%), representing all epilepsy centers across Canada. The minimum seizure free period required after epilepsy surgery before withdrawing AEDs, varied substantially among responders: 1 year in 50%, >2 years in 12%, >2 years in 3% after. The most important factors influencing the decision to withdraw AEDs a negative EEG before discontinuation (71%), patients’ preferences (78%) and the presence of unilateral mesial temporal sclerosis (70%). The most important factors against reduction were the following: patients’ wishes to resume driving (67%), focal (65%) or generalized (78%) epileptiform activity on EEG after surgery, persistent isolated auras (78%), any seizures after hospital discharge (81%), and presurgical multifocal/bilateral/diffuse findings (78%). Discussion Canadian epileptologists indicated that AED levels, EEG and MRI are typically done before discontinuing AEDs. Generally, a good candidate for stopping AEDs has focal pathology, is completely seizure free, had an anterior temporal lobe resection, complete resection of seizure focus, and has no epileptiform discharges on postoperative EEG. The data pertaining to self-reported practice styles, and actual practice may differ.
ISSN:	0920-1211 1872-6844