Abstract Details

Title Withdrawal of Antiepileptic Drugs After Stereotactic Laser Amygdalohippocampotomy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 12-001

Objective This study investigated the success rate of antiepileptic drug (AED) withdrawal following stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE), and identi?ed predictors of seizure recurrence.

Background Prior studies have shown a 25%-44% success rate in AED discontinuation after anterior temporal lobectomy (ATL), but there have not been any studies to date evaluating the success of AED withdrawal after SLAH.

Design/Methods We retrospectively assessed 65 patients who underwent SLAH for MTLE (59 lesional). Patients’ demographics, disease characteristics and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with AED withdrawal.

Results The mean period of observation post SLAH was 51 months (range 12 - 96 months) and the mean period to initial AED reduction was 21 months (range 12–60 months). AED reduction was attempted in 37 patients (57%), 13 (20%) of whom had seizure recurrence after initial reduction. At the end of the observation period, 14% of patients were seizure free without drugs, and 54% were seizure free with drugs. Compared with preoperative status, the number of AEDs were reduced or discontinued in 37% of patients, unchanged in 51% of them and increased in 12% of them. Discontinuation was achieved in 9 patients (14%), and all of them remained seizure free until the ?nal assessment. Multivariate analysis revealed that the pre-operative seizure frequency (p = .00092, by independent t-test) and the presence of acute post-operative seizures within two weeks post ablation (p = .014, by Chi-square test) were associated with increased risk for seizure recurrence post AED reduction.

Conclusions Successful SLAH for MTLE allows for AED reduction in a substantial portion of patients and complete AED withdrawal in a subset of them. Patients with higher pre-operative seizure frequency or early post-operative seizures exhibit a higher chance of relapse post AED reduction.

Authors/Disclosures
Arjun Athreya, MD (Lexington Medical Center) PRESENTER	Dr. Athreya has nothing to disclose.
Jon T. Willie, MD, PhD (Emory University)	Jon T. Willie, MD, PhD has received personal compensation in the range of $0-$499 for serving as a Consultant for AiM Medical. Jon T. Willie, MD, PhD has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Medtronic. Jon T. Willie, MD, PhD has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neuropace.
Robert Gross	No disclosure on file
Rebecca E. Matthews, MD (Emory University)	Dr. Matthews has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Penry Epilepsy Programs.
Ioannis Karakis, MD, FAAN (Emory University)	Dr. Karakis has received personal compensation for serving as an employee of Emory University School of Medicine. Dr. Karakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Karakis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GSK. Dr. Karakis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Epitel. Dr. Karakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Karakis has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Hill Ward Henderson.