Management of antiepileptic drugs following epilepsy surgery: A review

The favourable impact of surgery for intractable epilepsy on seizures is we ll documented. However, few studies have determined what changes in antiepi leptic drug (AED) therapy occur following surgery. Alterations in AED blood levels in the immediate postoperative period can result in breakthrough se izures. In long term follow-up, one-third to one-half of seizure-free patie nts after temporal lobectomy, the most common type of epilepsy surgery, sti ll require AED treatment which usually has been reduced from polytherapy to monotherapy. In our study of 93 patients followed two years after temporal lobectomy, polytherapy decreased from 78% before surgery to 14% postoperat ively, while medication was discontinued in 44%. Early reduction from polyt herapy to monotherapy can often be carried out in the immediate postoperati ve period but the most appropriate timing of cessation of AED treatment has yet to be determined. Patients undergoing extratemporal resections and oth er forms of epilepsy surgery associated with less favourable postoperative seizure control may achieve comparatively less reduction in antiepileptic m edication. We generally do not recommend stopping AEDs prior to one year af ter surgery.