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KMID : 1130620190150010084
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Journal of Clinical Neurology
2019 Volume.15 No. 1 p.84 ~ p.89
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Antiepileptic Drug Withdrawal after Surgery in Children with Focal Cortical Dysplasia: Seizure Recurrence and Its Predictors
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Choi Sun-Ah
Kim Soo-Yeon
Kim Woo-Joong
Shim Young-Kyu
Kim Hun-Min
Hwang Hee
Choi Ji-Eun
Lim Byung-Chan
Chae Jong-Hee
Chong Sang-Joon
Lee Ji-Yeoun
Phi Ji-Hoon
Kim Seung-Ki
Wang Kyu-Chang
Kim Ki-Joong
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Abstract
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Background and Purpose: This study investigated the seizure recurrence rate and potential predictors of seizure recurrence following antiepileptic drug (AED) withdrawal after resective epilepsy surgery in children with focal cortical dysplasia (FCD).
Methods: We retrospectively analyzed the records of 70 children and adolescents with FCD types I, II, and IIIa who underwent resective epilepsy surgery between 2004 and 2015 and were followed for at least 2 years after surgery.
Results: We attempted AED withdrawal in 40 patients. The median time of starting the AED reduction was 10.8 months after surgery. Of these 40 patients, 14 patients (35%) experienced seizure recurrence during AED reduction or after AED withdrawal. Half of the 14 patients who experienced recurrence regained seizure freedom after AED reintroduction and optimization. Compared with their preoperative status, the AED dose or number was decreased in 57.1% of patients, and remained unchanged in 14.3% after surgery. A multivariate analysis found that incomplete resection (p=0.004) and epileptic discharges on the postoperative EEG (p=0.025) were important predictors of seizure recurrence after AED withdrawal. Over the mean follow-up duration of 4.5 years after surgery, 34 patients (48.6% of the entire cohort) were seizure-free with and without AEDs.
Conclusions: Children with incomplete resection and epileptic discharges on postoperative EEG are at a high risk of seizure recurrence after drug withdrawal. Complete resection of FCD may lead to a favorable surgical outcome and successful AED withdrawal after surgery.
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KEYWORD
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cortical dysplasia, antiepileptic drugs, surgery, seizures, recurrence, epilepsy
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