J Clin Neurol.  2019 Jan;15(1):84-89. 10.3988/jcn.2019.15.1.84.

Antiepileptic Drug Withdrawal after Surgery in Children with Focal Cortical Dysplasia: Seizure Recurrence and Its Predictors

  • 1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 2Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. pednr@snu.ac.kr
  • 3Department of Pediatrics, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 4Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Korea.


This study investigated the seizure recurrence rate and potential predictors of seizure recurrence following antiepileptic drug (AED) withdrawal after resective epilepsy surgery in children with focal cortical dysplasia (FCD).
We retrospectively analyzed the records of 70 children and adolescents with FCD types I, II, and IIIa who underwent resective epilepsy surgery between 2004 and 2015 and were followed for at least 2 years after surgery.
We attempted AED withdrawal in 40 patients. The median time of starting the AED reduction was 10.8 months after surgery. Of these 40 patients, 14 patients (35%) experienced seizure recurrence during AED reduction or after AED withdrawal. Half of the 14 patients who experienced recurrence regained seizure freedom after AED reintroduction and optimization. Compared with their preoperative status, the AED dose or number was decreased in 57.1% of patients, and remained unchanged in 14.3% after surgery. A multivariate analysis found that incomplete resection (p=0.004) and epileptic discharges on the postoperative EEG (p=0.025) were important predictors of seizure recurrence after AED withdrawal. Over the mean follow-up duration of 4.5 years after surgery, 34 patients (48.6% of the entire cohort) were seizure-free with and without AEDs.
Children with incomplete resection and epileptic discharges on postoperative EEG are at a high risk of seizure recurrence after drug withdrawal. Complete resection of FCD may lead to a favorable surgical outcome and successful AED withdrawal after surgery.


cortical dysplasia; antiepileptic drugs; surgery; seizures; recurrence; epilepsy

MeSH Terms

Follow-Up Studies
Malformations of Cortical Development*
Multivariate Analysis
Retrospective Studies


  • Fig. 1 Longitudinal seizure and AED therapy outcomes of the overall cohort. AED: antiepileptic drug.

  • Fig. 2 Differential Kaplan-Meier survival curves for the timing of seizure recurrence in patients with recurrence on AED reduction (red dotted line) versus recurrence after AED discontinuation (blue solid line). AED: antiepileptic drug.


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