Schmidt Dieter, Baumgartner Christoph, Löscher Wolfgang
Epilepsy Research Group, Berlin, Germany.
Epilepsia. 2004 Feb;45(2):179-86. doi: 10.1111/j.0013-9580.2004.37803.x.
Although epilepsy surgery, especially temporal lobe epilepsy surgery, is well established to control seizures in patients remaining on antiepileptic drug (AED) treatment, less information is available about how many seizure-free surgical patients will relapse after discontinuation of AEDs under medical supervision.
A literature review yielded six retrospective clinical observations.
After planned discontinuation of AEDs in patients rendered seizure free after epilepsy surgery, most often various forms of temporal lobe surgery, the mean percentage recurrence rate in adults in four studies was 33.8%[95% confidence interval (CI), 32.4-35.2%], with maximum follow-up ranging from 1 to 5 years. Seizure recurrence increased during the follow-up of 1 to 3 years and occurred within 3 years of AED discontinuation. In one study of children with temporal lobe epilepsy, the recurrence rate was 20%. More than 90% of adult patients with seizure recurrence regained seizure control with reinstitution of previous AED therapy. Seizure recurrence was unaffected by the duration of postoperative AED treatment; as a consequence, delaying discontinuation beyond 1 to 2 years of complete postoperative seizure control seems to have no added benefit. The occurrence of rare seizures or auras after surgery did not eliminate the possibility of eventual successful AED discontinuation.
AED discontinuation is associated with a seizure recurrence in one in three patients rendered seizure free by epilepsy surgery. These results will be useful in counseling patients about discontinuing AED treatment after successful epilepsy surgery.
尽管癫痫手术，尤其是颞叶癫痫手术，已被充分证实可控制仍在接受抗癫痫药物（AED）治疗的患者的癫痫发作，但对于在医学监督下停用AED后，有多少无癫痫发作的手术患者会复发，相关信息较少。
文献回顾得出六项回顾性临床观察结果。
在癫痫手术后无癫痫发作的患者（大多数为各种形式的颞叶手术）按计划停用AED后，四项研究中成人的平均复发率为33.8%[95%置信区间（CI），32.4 - 35.2%]，最长随访时间为1至5年。癫痫复发在1至3年的随访期间增加，且发生在停用AED的3年内。在一项针对颞叶癫痫儿童的研究中，复发率为20%。超过90%癫痫复发的成年患者通过重新使用先前的AED治疗重新获得了癫痫控制。癫痫复发不受术后AED治疗持续时间的影响；因此，在术后完全无癫痫发作控制1至2年后再延迟停药似乎没有额外益处。手术后出现罕见癫痫发作或先兆并不排除最终成功停用AED的可能性。
癫痫手术后无癫痫发作的患者中，三分之一停用AED会出现癫痫复发。这些结果将有助于在成功进行癫痫手术后为患者提供关于停用AED治疗的咨询。
