Management of antiepileptic drugs following epilepsy surgery: A meta-analysis

Objective: No consensus exists regarding the management of antiepileptic drugs (AEDs) after successful epilepsy surgery (ES). We performed a meta-analysis with the most relevant evidence in this topic. Our aim was to provide evidence-based estimates of results on AEDs discontinuation after ES. Methods: We searched MEDLINE and Embase using Medical Subject Headings and keywords related to AEDs discontinuation after ES. Two reviewers independently applied the following inclusion criteria: original published research that directly compared seizure outcomes in patients having or not AEDs discontinuation after ES. Two investigators independently extracted data, resolving disagreements through discussion. A random and fixed-effect model was used to derive a pooled odds ratio (OR) for either seizure recurrence in both groups. Results: Of 257 abstracts initially identified by the search, 57 were reviewed as full text. Sixteen articles fulfilled eligibility criteria and described outcomes in 1456 patients with AEDs discontinuation and 685 patients with no discontinuation. The odds of having seizure recurrence after AEDs discontinuation was 0.39 times lower in patients with attempted discontinuation after surgery (OR 0.39, Cl 95% 0.300-0.507, p < 0.001). Most likely the difference is related with a selected population where discontinuation was attempted. Significance: Seizure recurrence was higher for patients without AED modification than for the withdrawal group. Patients with seizure recurrence after discontinuation can be managed easily after re-start of medications. The discontinuation of medications should be done in good candidates and the decision should be individualized taking into account clinical, electrographical, imaging and histopathological variables. (C) 2014 Elsevier B.V. All rights reserved.