Research progress of risk factors for recurrence of drug withdrawal after epilepsy surgery in children_Journal of Epilepsy

Authors：

YUAN Qingqing ,  CAO Dezhi

Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, China;

Corresponding author：

CAO Dezhi, Email: caodezhi888@aliyun.com

Keywords：

Epilepsy; Surgical treatment; Drug withdrawal; Recurrence; Risk factors

DOI：

10.7507/2096-0247.202412003

Video：

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Epilepsy is one of the most common neurological diseases in children, about 2/3 can be seizure-free after anti-seizure medications (ASMs) treatment, but there are still some drug-resistant epilepsy (DRE) need surgical treatment, epilepsy surgery including excision surgery, dissociation surgery and palliative surgery, surgery can make 30%~40% DRE fully controlled. Clinicians usually choose to discontinue ASMs after seizure-free for 1 to 2 years after epilepsy surgery, but there has been controversy about whether to discontinue ASMs after surgery in children with epilepsy, how long to discontinue ASMs, the timing of ASMs withdrawal, and there is still a lack of unified guidelines. This article will comprehensively analyze and summarize the risk of recurrence after ASMs withdrawal in children with epilepsy.

1.	Winter SF, Walsh D, Amos A, et al. The WHO intersectoral global action plan and epilepsy cascade target: towards a roadmap for implementation. Seizure, 2022, 103: 148-150.
2.	Guerrini R. Epilepsy in children. Lancet, 2006, 367(9509): 499-524.
3.	Fine A, Wirrell EC. Seizures in children. Pediatrics in Review, 2020, 41(7): 321-347.
4.	Czochnska J, Langner-Tyszka B, Losiowski Z, et al. Children who develop epilepsy in the first year of life: a prospective study. Developmental Medicine and Child Neurology, 1994, 36(4): 345-350.
5.	Rugg-Gunn F, Miserocchi A, McEvoy A. Epilepsy surgery. Practical Neurology, 2020, 20(1): 4-14.
6.	Chisolm PF, Warner JD, Hale AT, et al. Quantifying and reporting outcome measures in pediatric epilepsy surgery: a systematic review. Epilepsia, 2022, 63(11): 2754-2781.
7.	Kim JS, Park EK, Shim KW, et al. Hemispherotomy and functional hemispherectomy: indications and outcomes. Journal of Epilepsy Research, 2018, 8(1): 1-5.
8.	Blumcke I, Spreafico R, Haaker G, et al. Histopathological findings in brain tissue obtained during epilepsy surgery. The New England Journal of Medicine, 2017, 377(17): 1648-1656.
9.	Choi SA, Kim SY, Kim H, et al. Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia. Epilepsy Research, 2018, 139: 54-59.
10.	Sangare A, Marchi A, Pruvost-Robieux E, et al. The effectiveness of vagus nerve stimulation in drug-resistant epilepsy correlates with vagus nerve stimulation-induced electroencephalography desynchronization. Brain Connectivity, 2020, 10(10): 566-577.
11.	Chan AY, Rolston JD, Lee B, et al. Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis. Journal of Neurosurgery, 2019, 130(4): 1193-1202.
12.	González HFJ, Yengo-Kahn A, Englot DJ. Vagus nerve stimulation for the treatment of epilepsy. Neurosurgery Clinics of North America, 2019, 30(2): 219-230.
13.	Rolston JD, Englot DJ, Wang DD, et al. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review. Epilepsy & Behavior, 2015, 51: 13-17.
14.	Lancman G, Virk M, Shao H, et al. Vagus nerve stimulation vs. corpus callosotomy in the treatment of Lennox-Gastaut syndrome: a meta-analysis. Seizure, 2013, 22(1): 3-8.
15.	Isnard J, Taussig D, Bartolomei F, et al. French guidelines on stereoelectroencephalography (SEEG). Neurophysiologie Clinique, 2018, 48(1): 5-13.
16.	Catenox H, Bourdillon P, Guénot M, et al. The combination of stereo-EEG and radiofrequency ablation. Epilepsy Research, 2018, 142: 117-120.
17.	Boshiusen K, van Schooneveld MMJ, Uiterwaal CSPM, et al. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Annals of Neurology, 2015, 78(1): 104-114.
18.	Wu Y, Zhang Z, Liang P, et al. Early antiseizure medication withdrawal and risk of seizure recurrence in children after epilepsy surgery: a retrospective study. Epilepsy & Behavior, 2024, 150: 109556.
19.	Choi SA, Kim SY, Kim WJ, et al. Antiepileptic drug withdrawal after surgery in children with focal cortical dysplasia: seizure recurrence and its predictors. Journal of Clinical Neurology, 2019, 15(1): 84.
20.	Menon R, Rathore C, Sarma SP, et al. Feasibility of antiepileptic drug withdrawal following extratemporal resective epilepsy surgery. Neurology, 2012, 79(8): 770-776.
21.	Lamberink HJ, Otte WM, Geleijns K, et al. Antiepileptic drug withdrawal in medically and surgically treated patients: a meta-analysis of seizure recurrence and systematic review of its predictors. Epileptic Disorders, 2015, 17(3): 211-228.
22.	Rathore C, Panda S, Sarma PS, et al. How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy? Epilepsia, 2011, 52(3): 627-635.
23.	Cramer JA, Mintzer S, Wheless J, et al. Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Review of Neurotherapeutics, 2010, 10(6): 885-891.
24.	Langfitt JT, Holloway RG, McDermott MP, et al. Health care costs decline after successful epilepsy surgery. Neurology, 2007, 68(16): 1290-1298.
25.	Cole AJ, Wiebe S. Debate: Should antiepileptic drugs be stopped after successful epilepsy surgery? Epilepsia, 2008, 49(Suppl 9): 29-34.
26.	Yardi R, Irwin A, Kayyali H, et al. Reducing versus stopping antiepileptic medications after temporal lobe surgery. Annals of Clinical and Translational Neurology, 2014, 1(2): 115-123.
27.	Rowland NC, Englot DJ, Cage TA, et al. A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. Journal of Neurosurgery, 2012, 116(5): 1035-1041.
28.	Wei Z, Fallah A, Wang Y, et al. Influence of resective extent of epileptogenic tuber on seizure outcome in patients with tuberous sclerosis complex-related epilepsy: a systematic review and meta-analysis. Seizure, 2023, 108: 81-88.
29.	Zhang C, Kwan P. The concept of drug-resistant epileptogenic zone. Frontiers in Neurology, 2019, 10: 558.
30.	Kim YD, Heo K, Park SC, et al. Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. Epilepsia, 2005, 46(2): 251-257.
31.	Gloss D, Pargeon K, Pack A, et al. Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary: report of the AAN guideline subcommittee. Neurology, 2021, 97(23): 1072-1081.
32.	Lachhwani DK, Loddenkemper T, Holland KD, et al. Discontinuation of medications after successful epilepsy surgery in children. Pediatric Neurology, 2008, 38(5): 340-344.
33.	Schmidt D, Baumgartner C, Löscher W. Seizure recurrence after planned discontinuation of antiepileptic drugs in seizure-free patients after epilepsy surgery: a review of current clinical experience. Epilepsia, 2004, 45(2): 179-186.
34.	Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 522-530.
35.	Becker L, Makridis KL, Abad-Perez AT, et al. The importance of routine genetic testing in pediatric epilepsy surgery. Epilepsia Open, 2024, 9(2): 800-807.
36.	Komatsubara T, Kobayashi Y, Hiraishi A, et al. Recurrence rates and risk factors for seizure recurrence following antiseizure medication withdrawal in adolescent patients with genetic generalized epilepsy. Epilepsia Open, 2022, 7(2): 332-343.
37.	Lee SY, Lee JY, Kim DW, et al. Factors related to successful antiepileptic drug withdrawal after anterior temporal lobectomy for medial temporal lobe epilepsy. Seizure, 2008, 17(1): 11-18.
38.	Lamberink HJ, Boshiusen K, Otte WM, et al. Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. Epilepsia, 2018, 59(3): e28-e33.
39.	Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 2014, 55(4): 475-482.
40.	Chen Z, Brodie MJ, Liew D, et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. JAMA Neurology, 2018, 75(3): 279-286.
41.	Helmstaedter C, Beeres K, Elger CE, et al. Cognitive outcome of pediatric epilepsy surgery across ages and different types of surgeries: a monocentric 1-year follow-up study in 306 patients of school age. Seizure, 2020, 77: 86-92.

1. Winter SF, Walsh D, Amos A, et al. The WHO intersectoral global action plan and epilepsy cascade target: towards a roadmap for implementation. Seizure, 2022, 103: 148-150.
2. Guerrini R. Epilepsy in children. Lancet, 2006, 367(9509): 499-524.
3. Fine A, Wirrell EC. Seizures in children. Pediatrics in Review, 2020, 41(7): 321-347.
4. Czochnska J, Langner-Tyszka B, Losiowski Z, et al. Children who develop epilepsy in the first year of life: a prospective study. Developmental Medicine and Child Neurology, 1994, 36(4): 345-350.
5. Rugg-Gunn F, Miserocchi A, McEvoy A. Epilepsy surgery. Practical Neurology, 2020, 20(1): 4-14.
6. Chisolm PF, Warner JD, Hale AT, et al. Quantifying and reporting outcome measures in pediatric epilepsy surgery: a systematic review. Epilepsia, 2022, 63(11): 2754-2781.
7. Kim JS, Park EK, Shim KW, et al. Hemispherotomy and functional hemispherectomy: indications and outcomes. Journal of Epilepsy Research, 2018, 8(1): 1-5.
8. Blumcke I, Spreafico R, Haaker G, et al. Histopathological findings in brain tissue obtained during epilepsy surgery. The New England Journal of Medicine, 2017, 377(17): 1648-1656.
9. Choi SA, Kim SY, Kim H, et al. Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia. Epilepsy Research, 2018, 139: 54-59.
10. Sangare A, Marchi A, Pruvost-Robieux E, et al. The effectiveness of vagus nerve stimulation in drug-resistant epilepsy correlates with vagus nerve stimulation-induced electroencephalography desynchronization. Brain Connectivity, 2020, 10(10): 566-577.
11. Chan AY, Rolston JD, Lee B, et al. Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis. Journal of Neurosurgery, 2019, 130(4): 1193-1202.
12. González HFJ, Yengo-Kahn A, Englot DJ. Vagus nerve stimulation for the treatment of epilepsy. Neurosurgery Clinics of North America, 2019, 30(2): 219-230.
13. Rolston JD, Englot DJ, Wang DD, et al. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review. Epilepsy & Behavior, 2015, 51: 13-17.
14. Lancman G, Virk M, Shao H, et al. Vagus nerve stimulation vs. corpus callosotomy in the treatment of Lennox-Gastaut syndrome: a meta-analysis. Seizure, 2013, 22(1): 3-8.
15. Isnard J, Taussig D, Bartolomei F, et al. French guidelines on stereoelectroencephalography (SEEG). Neurophysiologie Clinique, 2018, 48(1): 5-13.
16. Catenox H, Bourdillon P, Guénot M, et al. The combination of stereo-EEG and radiofrequency ablation. Epilepsy Research, 2018, 142: 117-120.
17. Boshiusen K, van Schooneveld MMJ, Uiterwaal CSPM, et al. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Annals of Neurology, 2015, 78(1): 104-114.
18. Wu Y, Zhang Z, Liang P, et al. Early antiseizure medication withdrawal and risk of seizure recurrence in children after epilepsy surgery: a retrospective study. Epilepsy & Behavior, 2024, 150: 109556.
19. Choi SA, Kim SY, Kim WJ, et al. Antiepileptic drug withdrawal after surgery in children with focal cortical dysplasia: seizure recurrence and its predictors. Journal of Clinical Neurology, 2019, 15(1): 84.
20. Menon R, Rathore C, Sarma SP, et al. Feasibility of antiepileptic drug withdrawal following extratemporal resective epilepsy surgery. Neurology, 2012, 79(8): 770-776.
21. Lamberink HJ, Otte WM, Geleijns K, et al. Antiepileptic drug withdrawal in medically and surgically treated patients: a meta-analysis of seizure recurrence and systematic review of its predictors. Epileptic Disorders, 2015, 17(3): 211-228.
22. Rathore C, Panda S, Sarma PS, et al. How safe is it to withdraw antiepileptic drugs following successful surgery for mesial temporal lobe epilepsy? Epilepsia, 2011, 52(3): 627-635.
23. Cramer JA, Mintzer S, Wheless J, et al. Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Review of Neurotherapeutics, 2010, 10(6): 885-891.
24. Langfitt JT, Holloway RG, McDermott MP, et al. Health care costs decline after successful epilepsy surgery. Neurology, 2007, 68(16): 1290-1298.
25. Cole AJ, Wiebe S. Debate: Should antiepileptic drugs be stopped after successful epilepsy surgery? Epilepsia, 2008, 49(Suppl 9): 29-34.
26. Yardi R, Irwin A, Kayyali H, et al. Reducing versus stopping antiepileptic medications after temporal lobe surgery. Annals of Clinical and Translational Neurology, 2014, 1(2): 115-123.
27. Rowland NC, Englot DJ, Cage TA, et al. A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. Journal of Neurosurgery, 2012, 116(5): 1035-1041.
28. Wei Z, Fallah A, Wang Y, et al. Influence of resective extent of epileptogenic tuber on seizure outcome in patients with tuberous sclerosis complex-related epilepsy: a systematic review and meta-analysis. Seizure, 2023, 108: 81-88.
29. Zhang C, Kwan P. The concept of drug-resistant epileptogenic zone. Frontiers in Neurology, 2019, 10: 558.
30. Kim YD, Heo K, Park SC, et al. Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy. Epilepsia, 2005, 46(2): 251-257.
31. Gloss D, Pargeon K, Pack A, et al. Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary: report of the AAN guideline subcommittee. Neurology, 2021, 97(23): 1072-1081.
32. Lachhwani DK, Loddenkemper T, Holland KD, et al. Discontinuation of medications after successful epilepsy surgery in children. Pediatric Neurology, 2008, 38(5): 340-344.
33. Schmidt D, Baumgartner C, Löscher W. Seizure recurrence after planned discontinuation of antiepileptic drugs in seizure-free patients after epilepsy surgery: a review of current clinical experience. Epilepsia, 2004, 45(2): 179-186.
34. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 522-530.
35. Becker L, Makridis KL, Abad-Perez AT, et al. The importance of routine genetic testing in pediatric epilepsy surgery. Epilepsia Open, 2024, 9(2): 800-807.
36. Komatsubara T, Kobayashi Y, Hiraishi A, et al. Recurrence rates and risk factors for seizure recurrence following antiseizure medication withdrawal in adolescent patients with genetic generalized epilepsy. Epilepsia Open, 2022, 7(2): 332-343.
37. Lee SY, Lee JY, Kim DW, et al. Factors related to successful antiepileptic drug withdrawal after anterior temporal lobectomy for medial temporal lobe epilepsy. Seizure, 2008, 17(1): 11-18.
38. Lamberink HJ, Boshiusen K, Otte WM, et al. Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. Epilepsia, 2018, 59(3): e28-e33.
39. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 2014, 55(4): 475-482.
40. Chen Z, Brodie MJ, Liew D, et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. JAMA Neurology, 2018, 75(3): 279-286.
41. Helmstaedter C, Beeres K, Elger CE, et al. Cognitive outcome of pediatric epilepsy surgery across ages and different types of surgeries: a monocentric 1-year follow-up study in 306 patients of school age. Seizure, 2020, 77: 86-92.

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