Abstracts

RATIONALE: The goal of anterior temporal lobectomy (ATL) in medically intractable complex partial epilepsy is a seizure-free status. Once this is achieved, a secondary goal is reduction in number and dosage of antiepileptic drugs (AEDs), in order to reduce the burden of associated side effects.
Our objective was to determine whether early AED reduction following anterior temporal lobectomy for medically-intractable complex partial epilepsy was accomplished safely in our practice.
METHODS: Thirty-one patients underwent ATL for medically intractable complex partial epilepsy at Loma Linda University Medical Center (LLUMC) from December 1991 to November 2001.
In a retrospective review, patients were considered [dsquote]seizure-free[dsquote] if they did not experience complex partial seizures while taking the prescribed medications until AED reduction was initiated, or until the time of most recent clinic or mail follow-up.
We provide descriptive data of the patients, their outcomes, and the timing and results of AED reduction in patients rendered seizure-free.
RESULTS: Twenty-five of the 31 patients became seizure-free on their preoperative AEDs after one operation (81%). Three other patients required additional ipsilateral temporal lobe resection to become seizure-free. AEDs were not reduced in these three patients. AEDs were increased in two patients to control simple partial seizures. AEDs were reduced in the remaining 23 patients (74% of the 31 patients). Their characteristics were similar to those of the entire group. Follow-up averaged 2.9 +/- 2.4 years (mean +/- standard deviation [M+/-SD]) after surgery. AED reduction was initiated 4.7 +/- 7.2 (M+/- SD) months after surgery. This occurred within one month of surgery in 43% of patients, within two months in 65%, within 6 months in 84% and within 12 months in 91%. As a result, polytherapy use dropped from 61% preoperatively to 22% 6 months postoperatively, rising slightly to 26% at last follow-up.
Seizures emerged in six patients who followed the AED reduction as prescribed. Seizures stopped in five of these patients after AEDs were increased or alternative AEDs introduced. Medication adjustment continues in the sixth patient.
CONCLUSIONS: Early medication reduction to ameliorate side effects was successful in most patients who became seizure-free after ATL. Early reduction of AEDs was initiated in response to patients requests. Once they became seizure-free, they were unwilling to tolerate the same burden of AED side effects that they accepted when they were experiencing seizures preoperatively.
We conclude that early, gradual, post-operative medication reduction in patients who become seizure free after ATL may be accomplished with relative safety to the degree needed to ameliorate AED side effects.