From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India.
Neurology. 2018 Jul 17;91(3):e208-e216. doi: 10.1212/WNL.0000000000005820. Epub 2018 Jun 20.
To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy.
We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug.
Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7-17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2%) on attempted withdrawal. After a median postrecurrence follow-up of 7 years, 79 (86%) of them were seizure-free during the terminal 2 years. AEDs could be stopped in 17 patients (18.5%) and doses were reduced in another 57 patients (62%). Patients with febrile seizures, normal postoperative EEG at 1 year, and duration of epilepsy of <20 years (FND20 score) had 17% risk of seizure recurrence on attempted AED withdrawal. We also formulated a score to predict the chances of AED freedom for the whole cohort.
Patients with seizure recurrence on AED withdrawal have good outcome with 86% becoming seizure-free and 18% becoming drug-free after initial recurrence. A FND20 score helps in predicting recurrence on AED withdrawal.
研究在接受内侧颞叶癫痫前颞叶切除术（TLE）后因停用抗癫痫药物（AED）而出现癫痫复发的长期结果。
我们回顾性研究了至少术后 5 年随访的接受内侧颞叶癫痫前颞叶切除术的患者的 AED 概况。仅纳入海马硬化或 MRI 正常的患者。对于服用≥2 种药物的患者，在术后 3 个月开始停用 AED，对于服用单种药物的患者，在术后 1 年开始停用 AED。
共有 384 例患者接受了中位数为 12 年（范围 7-17 年）的术后随访。其中 316 例（82.3%）在末次随访的最后 1 年内无癫痫发作。尝试停用 AED 的患者为 326 例（84.9%）。末次随访时，207 例（53.9%）患者停止服用 AED。在尝试停药的 326 例患者中，92 例（28.2%）出现癫痫复发。在中位复发后随访 7 年后，其中 79 例（86%）在末次随访的最后 2 年内无癫痫发作。17 例（18.5%）患者能够停药，另有 57 例（62%）患者减少了剂量。有热性惊厥史、术后 1 年 EEG 正常和癫痫持续时间<20 年（FND20 评分）的患者，有 17%的风险在尝试停用 AED 后出现癫痫复发。我们还制定了一个评分来预测整个队列中 AED 无发作的可能性。
在尝试停用 AED 后出现癫痫复发的患者，有 86%的患者在复发后无癫痫发作，18%的患者无需服用药物，FND20 评分有助于预测停用 AED 后的复发风险。
