Abstracts

Epilepsy Surgery offers a cure for selective patients with refractory seizures. After successful epilepsy surgery some patients can be successfully tapered off anticonvulsants potentially improving their quality of life further. Although Epileptologists tend to withdraw anticonvulsants many months or even years after successful surgery , systemic studies about the best timing for anticonvulsant withdrawal are lacking. We present our experience with rapid withdrawal of anticonvulsants in a group of patients after epilepsy surgery Patients with epilepsy surgery followed in our Epilepsy Surgery Program were offered a trail of anticonvulsants withdrawal 6 weeks after epilepsy surgery with complete withdrawal at 12 weeks. Recurrence of seizures was monitored. Patients with early postoperative seizures, more than 4 anticonvulsants, history of generalized status epilepticus and patients on phenobarbital were excluded. Among 27 patients with epilepsy surgery rapid withdrawal of anticonvulsants was attempted in 15 (9 Females). Age ranged between 6-57 years (mean 28.3 years). Eight patients had temporal lobectomy , 6 extartemporal resections and 1 with hemishperectomy. Pathology was consistent with mesiotemporal sclerosis in 4, focal cortical dysplasia in 4, low grade tumor in 2 , atrophy and gliosis is 2 and normal in 3. Seizures recurred in 8 of the 15 patients , 4 during and 4 after complete drug withdrawal. Among the 8 patients with seizure recurrence 4 continued to have seizures after reinstating anticonvulsants while seizures stopped in the other 4 after restarting or increasing anticonvulsants. Seven patients remained seizure free with a mean follow-up of 9 months postsurgery (6-19 months). Pathological examination of the patients who remained seizure free was cortical dysplasia in 4, low grade tumor in 2 and one patient with mesiotemporal sclerosis . Drug withdrawal was not successful in any patient with normal postoperative histopathology. In selective patients with epilepsy surgery pathological findings may be a factor in successful early withdrawal of anticonvulsants. Further studies are needed to define patients who could benefit from early anticonvulsant withdrawal after epilepsy surgery and the effects of that on quality of life.