Rationale:
About 34-50% of patients with focal epilepsy who undergo resective epilepsy surgery continue to experience seizures. Patients who fail epilepsy surgery may eventually become seizure-free with additional medical interventions. However, there is limited data to suggest which anti-seizure medications following a failed epilepsy surgery may be of most benefit.Methods:
We reviewed medical records of patients who failed resective epilepsy surgery performed 2010 through 2014 at Vanderbilt University Medical Center. We included patients who had at least two years of follow-up. We identified patients who were still experiencing seizures one year after surgery and followed their course. We selected patients who became seizure-free at last follow-up and reviewed what intervention contributed to their seizure freedom.
Results:
Out of forty three patients who were still having seizures at one year after surgery, twelve were seizure-free at last follow-up. The changes that resulted in seizure freedom included initiation or uptitration of lamotrigine in four patients, initiation of clobazam in three patients, titration of tiagabine in two patients, titration of cenobamate in one patient, initiation of brivaracetam in one patient, and initiation of lacosamide in one patient.
Conclusions: Seizure freedom may be achieved with medication changes after apparently failed epilepsy surgery. In this group of patients, the changes that most commonly resulted in seizure freedom included addition or optimization of lamotrigine, and the addition of clobazam and tiagabine.
Funding:
None