Authors :
Presenting Author: Ali Alanazi, MBBS, SBN, ABCN – 1-Division of Neurology,King Abdulaziz Medical City Riyadh, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia 2-King Abdullah International Medical Research Center, Riyadh, Saudi Arabia 3-King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Jnadi Madkhali, MBBS – King Abdulaziz Medical City-Riyadh; Abdulkarim Alghamdi, Student – College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; Fay Alnafisi, Student – College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabi; Nazish Masud, M.D., M.Sc. – Department of Biostatistics, Epidemiology and Environmental Health Sciences Jiann-Ping Hsu College Public Health – Georgia Southern University,Statesboro, GA , USA; Seraj Makkawi, MBBS, MSc, FRCPC, FAAN, ABPN, CSCN (EEG/EMG), MSCS, CRND – College of Medicine – 1-College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. 2- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia 3- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.
Rationale:
In non-tumoral epilepsy, anti-seizure medications (ASM) can be withdrawn after epilepsy surgery.
1 Epileptologists may start tapering ASM nine to twenty four months of seizure freedom after the surgery. However, the exact time of ASM withdrawal is debatable.
2 In patients with gliomas, seizures recur in 26% after ASM withdrawal. However, continual use of ASM in seizure-free patients after successful tumor surgery is still controversial.
3 This study aims to study seizures prognosis and predictors of seizure freedom after primary intracranial tumor surgery.
Methods:
This was a retrospective cross-sectional observational study from 2016 to 2022. It was conducted in two tertiary medical centers in Saudi Arabia: King Abdulaziz Medical City in Riyadh and Jeddah. We included all patients older than 18 years of age with biopsy proven primary intracranial tumor if they had had at least one seizure before the surgery. Patients who had had epilepsy or other central nervous system disorders prior to the tumor diagnosis were excluded. Also, we excluded patients who had never had post-surgery follow-up visits.
Results:
Fifty-one patients were included. Forty patients (78%) were females. The mean age was 43 years. The most common tumor location was frontal lobe in 26 (51%) patients. Tumors were in temporal lobe and occipital lobe in 8 (16%) patients and one (2%) patient respectively. Fifteen (29%) patients had multi-lobar involvements and one (2%) patient had intraventricular tumor. After the surgery, ASMs were stopped or tapered in 21 (41%) patients. Of them, 14 (67%) patients had no seizure recurrence, while only 7 patients (33%) had seizure recurrence. Of the 30 (59%) patients who continued on ASM, nineteen (63%) patients had no seizures while 11 (37%) patients experienced one or more seizures.
Conclusions:
Majority of patients with epilepsy due to intracranial primary tumors achieved seizure freedom after the surgery. The absence of difference in seizure recurrence between withdrawal and continuation group is probably due to clinician’s cautious selection of patient who will withdraw ASM. Larger cohort of patients and further advanced analysis is needed to inform selection of patient with high likelihood of seizure freedom after ASM discontinuation.
References
1 Rathorte C, Sarma SP, Radhakrishnan K. Feasibility of antiepileptic drug withdrawal following extratemporal resective epilepsy surgery. Neurology. 2012;79(8):770–6.
2 Ziemba KS, Wellik KE, Hoffman-Snyder C, et al. Timing of antiepileptic drug withdrawal in adult epilepsy patients after neocortical surgical resection: a critically appraised topic. Neurologist. 2011;17(3):176–8.
3 Kerkhof M, Koekkoek JAF, Vos MJ, et al. Withdrawal of antiepileptic drugs in patients with low grade and anaplastic glioma after long-term seizure freedom: a prospective observational study. J Neurooncol. 2019;142(3):463–70.
Funding: No funding was received in support of this abstract