J Korean Child Neurol Soc.  2017 Sep;25(3):127-132. 10.26815/jkcns.2017.25.3.127.

Discontinuing Antiepileptic Drugs after Pediatric Epilepsy Surgery for Focal Cortical Dysplasia

Affiliations
  • 1Division of Pediatric Neurology, Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea. SEHEEKIM@yuhs.ac
  • 2Division of Pediatric Neurosurgery, Department of Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Antiepileptic drugs (AEDs) can be discontinued in a subset of patients after surgery. We aimed to identify the factors related to successful AED withdrawal after surgery in pediatric patients with focal cortical dysplasia (FCD).
METHODS
The study included 134 patients who underwent resective surgery for FCD at Severance Hospital between 2003 and 2014. Age of seizure onset, epilepsy duration, and location and histopathological classification of the FCD were compared between patients who experienced seizure recurrence and those who did not. The interval between surgery and initiation of AED reduction was also compared.
RESULTS
In total, 134 patients were included. The median age at seizure onset was 1.0 year (interquartile range [IQR], 0.3-5.0). The median follow-up duration was 6.0 years (IQR, 1.0-13.0). AED withdrawal was attempted in 89 (66%), and 61 (69%) patients remained seizure-free. Of 61 patients, 38 (62%) were successfully weaned off all AEDs. Seizures recurred in 28 (31%) patients. The mean duration between surgery and initiation of AED reduction did not significantly differ between the seizure recurrence (4.5 months, IQR, 2.7-8.7) and non-recurrence groups (1.9 months, IQR, 0.5-5.4) (P<0.006). Patients who had FCD type IIb (39% vs. 7%, P=0.004) were more likely to be in the non-recurrence group than in the recurrence group (P=0.031).
CONCLUSION
Surgical resection offers patients with FCD an opportunity to completely discontinue their AEDs. Early AED discontinuation may be pursued in patients with FCD in cases of complete resection.

Keyword

Focal cortical dysplasia; Epilepsy surgery; Pediatric; Antiepileptic drugs; Withdraw; Reduce

MeSH Terms

Anticonvulsants*
Classification
Epilepsy*
Follow-Up Studies
Humans
Malformations of Cortical Development*
Recurrence
Seizures
Anticonvulsants
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