Withdrawal of antiepileptic drugs after stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy

Arjun Athreya, Rebecca E. Fasano, Daniel L. Drane, Scott R. Millis, Jon T. Willie, Robert E. Gross, Ioannis Karakis

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: This retrospective study investigated the success rate of withdrawal of antiepileptic drugs (AEDs) following stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE), and identified predictors of seizure recurrence. Materials and methods: We retrospectively assessed 65 patients who underwent SLAH for MTLE (59 lesional). Patients’ demographics, disease characteristics and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with withdrawal of AEDs. Results: The mean period of observation post SLAH was 51 months (range 12–96 months) and the mean period to initial reduction of AEDs was 21 months (range 12–60 months). Reduction of AEDs was attempted in 37 patients (57 %) who were seizure free post SLAH and it was successful in approximately 2/3 of them. From the remainder 1/3 who relapsed, nearly all regained seizure control after reinstitution of their AEDs. The likelihood of relapse after reduction of AEDs was predicted only by pre-operative seizure frequency. At the end of the observation period, approximately 14 % of all SLAH patients were seizure free without AEDs and approximately 54 % remained seizure free on AEDs. Compared with preoperative status, the number of AEDs were reduced in 37 % of patients, unchanged in 51 % of them and increased in 12 % of them. Conclusions: Successful SLAH for MTLE allows for reduction of AEDs in a significant portion of patients and complete withdrawal of AEDs in a subset of them. Patients with higher pre-operative seizure frequency exhibit a greater chance of relapse post reduction of AEDs.

Original languageEnglish
Article number106721
JournalEpilepsy Research
Volume176
DOIs
StatePublished - Oct 2021

Keywords

  • Antiepileptic drugs
  • Epilepsy
  • Epilepsy surgery
  • Laser ablation
  • Stereotactic laser amygdalohippocampotomy

Fingerprint

Dive into the research topics of 'Withdrawal of antiepileptic drugs after stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy'. Together they form a unique fingerprint.

Cite this