Department of Medicine-Division of Neurology, University of Saskatchewan, Saskatoon, Canada.
Epilepsy Res. 2012 Nov;102(1-2):23-33. doi: 10.1016/j.eplepsyres.2012.04.018. Epub 2012 May 15.
To identify the perceived practice among Canadian epileptologists regarding discontinuation of antiepileptic drugs (AEDs) following successful resective surgery for temporal and extratemporal surgery.
We performed a survey of pediatric and adult epileptologists in Canada, using a 77-item questionnaire to explore attitudes, timing, rate of withdrawal, and factors contributing to the decision to withdraw AEDs after successful epilepsy surgery. Surveys were mailed with a postage-paid return envelope. Two subsequent surveys were mailed to non-respondents at 15 days intervals. All procedures received institutional review board approval.
Surveys were sent to 82 epileptologists in all the Canadian provinces. Sixty-six physicians answered the survey (80.5%), representing all epilepsy centers across Canada. The minimum seizure free period required after epilepsy surgery before withdrawing AEDs, varied substantially among responders: <6 months in 10%, 6-11 months in 21%, >1 year in 50%, >2 years in 12%, >2 years in 3% after. The most important factors influencing the decision to withdraw AEDs a negative EEG before discontinuation (71%), patients' preferences (78%) and the presence of unilateral mesial temporal sclerosis (70%). The most important factors against reduction were the following: patients' wishes to resume driving (67%), focal (65%) or generalized (78%) epileptiform activity on EEG after surgery, persistent isolated auras (78%), any seizures after hospital discharge (81%), and presurgical multifocal/bilateral/diffuse findings (78%).
Canadian epileptologists indicated that AED levels, EEG and MRI are typically done before discontinuing AEDs. Generally, a good candidate for stopping AEDs has focal pathology, is completely seizure free, had an anterior temporal lobe resection, complete resection of seizure focus, and has no epileptiform discharges on postoperative EEG. The data pertaining to self-reported practice styles, and actual practice may differ.
旨在确定加拿大癫痫学家在颞叶和颞外手术成功切除后停止使用抗癫痫药物 (AED) 的实际做法。
我们对加拿大的儿科和成人癫痫学家进行了一项调查，使用了 77 项问卷来探讨态度、停药时间、停药率以及成功癫痫手术后决定停药的因素。调查通过邮资已付的回邮信封寄出。在 15 天的间隔时间内向未回复者寄出了另外两份调查。所有程序均获得机构审查委员会的批准。
所有加拿大省份的 82 名癫痫学家都收到了调查。66 名医生回答了调查（80.5%），代表了加拿大各地的所有癫痫中心。在成功手术后停止使用 AED 之前，需要达到的最低无癫痫发作期，在应答者中差异很大：<6 个月占 10%，6-11 个月占 21%，>1 年占 50%，>2 年占 12%，>2 年占 3%。影响停药决定的最重要因素是：术前 EEG 为阴性（71%）、患者的喜好（78%）和单侧内侧颞叶硬化（70%）。反对减少 AED 的最重要因素是：患者希望恢复驾驶（67%）、手术后 EEG 上出现局灶性（65%）或全面性（78%）癫痫样活动、持续孤立的先兆（78%）、出院后任何发作（81%）和术前多灶性/双侧/弥漫性发现（78%）。
加拿大癫痫学家表示，通常在停止使用 AED 之前会进行 AED 水平、EEG 和 MRI 检查。一般来说，适合停止使用 AED 的患者具有局灶性病变、完全无癫痫发作、接受了前颞叶切除术、完全切除了癫痫灶、术后 EEG 无癫痫样放电。与实际实践相关的自我报告的实践模式可能存在差异。
