Abstract
Background: Although epilepsy surgery is a recognized treatment option for drug-resistant epilepsies since several decades, the management of antiepileptic drugs (AEDs) after successful surgery still remains one of the most difficult and unsolved therapeutic challenges. Indeed, no systematic controlled trials have been specifically conducted so far and no consensus or standardized guidelines regarding postsurgical drug discontinuation policy and procedures are available.
Methods: In this paper, we aim to provide an updated overview on the present knowledge on this topic, which is based mainly on retrospective studies reporting practices used in individual centers. Results: Currently available data suggest that: 1) rate of seizure recurrence appears to be higher in patients undergoing early (before 6 months or 9 months according to different studies) AED withdrawal; 2) seizures that recur during AED tapering are easier to control than unprovoked postoperative seizure relapses; 3) there is no evidence to support negative long-term implications on seizure outcomes in patients who attempted AED withdrawal. In the pediatric age group, shorter intervals from surgery to AED reduction and to complete AED discontinuation predict seizure relapse during or after AED reduction/withdrawal. However, this does not correlate with the chances of regaining seizure freedom after drug reintroduction. Conclusion: Carefully conducted prospective longitudinal studies and randomized controlled trials are warranted to establish the correct post-surgical pharmacologic treatment and to identify the best candidates for AEDs discontinuation.Keywords: Epilepsy surgery, drug resistance, AED, AED withdrawal, AED tapering, seizure relapse, seizure outcome.
Current Pharmaceutical Design
Title:Management of Antiepileptic Treatment After Epilepsy Surgery - Practices and Problems
Volume: 23 Issue: 37
Author(s): Guido Rubboli*, Anne Sabers, Peter Uldall and Kristina Malmgren
Affiliation:
- Danish Epilepsy Center, Filadelfia/University of Copenhagen, Dianalund,Denmark
Keywords: Epilepsy surgery, drug resistance, AED, AED withdrawal, AED tapering, seizure relapse, seizure outcome.
Abstract: Background: Although epilepsy surgery is a recognized treatment option for drug-resistant epilepsies since several decades, the management of antiepileptic drugs (AEDs) after successful surgery still remains one of the most difficult and unsolved therapeutic challenges. Indeed, no systematic controlled trials have been specifically conducted so far and no consensus or standardized guidelines regarding postsurgical drug discontinuation policy and procedures are available.
Methods: In this paper, we aim to provide an updated overview on the present knowledge on this topic, which is based mainly on retrospective studies reporting practices used in individual centers. Results: Currently available data suggest that: 1) rate of seizure recurrence appears to be higher in patients undergoing early (before 6 months or 9 months according to different studies) AED withdrawal; 2) seizures that recur during AED tapering are easier to control than unprovoked postoperative seizure relapses; 3) there is no evidence to support negative long-term implications on seizure outcomes in patients who attempted AED withdrawal. In the pediatric age group, shorter intervals from surgery to AED reduction and to complete AED discontinuation predict seizure relapse during or after AED reduction/withdrawal. However, this does not correlate with the chances of regaining seizure freedom after drug reintroduction. Conclusion: Carefully conducted prospective longitudinal studies and randomized controlled trials are warranted to establish the correct post-surgical pharmacologic treatment and to identify the best candidates for AEDs discontinuation.Export Options
About this article
Cite this article as:
Rubboli Guido*, Sabers Anne, Uldall Peter and Malmgren Kristina, Management of Antiepileptic Treatment After Epilepsy Surgery - Practices and Problems, Current Pharmaceutical Design 2017; 23 (37) . https://dx.doi.org/10.2174/1381612823666170823111712
DOI https://dx.doi.org/10.2174/1381612823666170823111712 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Synthesis and Structure-Activity Relationship on Anticonvulsant Aryl Semicarbazones
Medicinal Chemistry An Emerging Antiarrhythmic Target: Late Sodium Current
Current Pharmaceutical Design Exploring the Role of Aggregated Proteomes in the Pathogenesis of Alzheimer’s Disease
Current Protein & Peptide Science GABA and Neuroactive Steroid Interactions in Glia: New Roles for Old Players?
Current Neuropharmacology Imaging of P-glycoprotein Function and Expression to Elucidate Mechanisms of Pharmacoresistance in Epilepsy
Current Topics in Medicinal Chemistry Metabotropic Glutamate Receptor Ligands as Potential Therapeutics for Addiction
Current Drug Abuse Reviews Cardiovascular Toxicity from the Perspective of Oxidative Stress, Electron Transfer, and Prevention by Antioxidants
Current Vascular Pharmacology Bridging Over the Troubled Heterogeneity of SPG-Related Pathologies: Mechanisms Unite What Genetics Divide
Current Molecular Medicine Drugs Treatment of Pain in Multiple Sclerosis
Current Clinical Pharmacology Flavonoids as Natural Inhibitors of Jack Bean Urease Enzyme
Letters in Drug Design & Discovery A One Pot Green Synthesis of 3,4 Dihydropyrimidin-2-(1H)-ones/Thiones Catalyzed By MgO-ZrO<sub>2</sub> Under Solvent-Free Conditions
Letters in Organic Chemistry Subdural Pharmacotherapy for the Treatment of Intractable Focal Neocortical Epilepsy
Drug Delivery Letters Congenital Malformations Attributed to Prenatal Exposure to Cyclophosphamide
Anti-Cancer Agents in Medicinal Chemistry New Therapeutic Strategies in Perinatal Stroke
Current Drug Targets - CNS & Neurological Disorders Phosphoinositide-3-kinases as the Novel Therapeutic Targets for the Inflammatory Diseases: Current and Future Perspectives
Current Drug Targets Brain Aging and Disorders of the Central Nervous System: Kynurenines and Drug Metabolism
Current Drug Metabolism Editorial (Thematic Issue: In vivo MRS: Techniques and Applications)
Current Molecular Imaging (Discontinued) Towards a “Metabolic” Subtype of Major Depressive Disorder: Shared Pathophysiological Mechanisms May Contribute to Cognitive Dysfunction
CNS & Neurological Disorders - Drug Targets Potential Therapeutic Interest of Adenosine A2A Receptors in Psychiatric Disorders
Current Pharmaceutical Design Quinoline Derivatives: Candidate Drugs for a Class B G-Protein Coupled Receptor, the Calcitonin Gene-Related Peptide Receptor, a Cause of Migraines
CNS & Neurological Disorders - Drug Targets