Discontinuation of anticonvulsant medication after epilepsy surgery in children

Purpose: To evaluate the long-term outcome of medication-reduction/discontinuation trials after epilepsy surgery in pediatric patients. Methods: Of the total Bonn pediatric surgical sample (1988-2001; n = 251), we were able to obtain postsurgical follow-up data for 232 patients. We surveyed 140 of these patients by using a standardized telephone interview that addressed medication-reduction/discontinuation trials. Results: Of the 140 surveyed patients, 102 completely discontinued medication. Seven of these patients had recurring seizures that were controlled again after restarting the medication. Of 102 patients, 101 were completely seizure free during the 3 months before the survey. Postsurgical epileptic events before the trial significantly increased the risk for recurring epileptic events after the trial. Two surveyed patients lost postsurgical seizure freedom after medication reduction. We were also able to identify from the records another nine patients with complete medication discontinuation and seven patients with medication reduction. Two of these latter patients lost postsurgical seizure freedom despite restarting their medication. The total rate of patients with medication-reduction/discontinuation trials was 55%. The seizure recurrence rate in these patients was 10%. Recurring seizures could not be controlled by restarted medication in 3% of the trials. Currently, 90% of patients with discontinuation trials were seizure free without medication. Conclusions: The reduction/withdrawal of anticonvulsant medication after successful epilepsy surgery has a low risk of seizure recurrence for pediatric patients in long-term follow-up, particularly in cases of complete postsurgical seizure freedom before the trial.