Abstracts

We observed a number of patients becoming seizure-free with medication changes after they appeared to have failed epilepsy surgery. It is not known if seizures become more responsive to antiepileptic drugs (AEDs) after surgical failure. We encountered nine patients with persistent refractory seizures following epilepsy surgery, who subsequently became seizure-free with medication changes. We reviewed their medical records and recorded clinical data including seizure localization, type of epilepsy surgery, and interval between surgery and eventual remission. We also recorded the medication changes that eventually rendered patients seizure free. We noted whether the last medications added were previously failed before surgery. All nine patients had temporal lobe epilepsy. Three underwent right and six left temporal lobectomy. Seizures persisted for 2-6 years after surgery, before remission was achieved. Two patients had previously failed AEDs that later controlled the seizures- these AEDs were felbamate and levetiracetam. Among the remaining seven patients, two became seizure free after introducing lamotrogine, two after levetiracetam, two after tiagabine, and one after oxcarbazepine. Surgical failure can occasionally be reversed with AED changes. In some instances AEDs previously failed become effective postoperatively, suggesting a change in seizure responsiveness in some patients who appear to have derived no benefit from surgery.