Why are antiepileptic drugs continued after successful epilepsy surgery in adults?

OBJECTIVE: Studies have demonstrated that a substantial number of patients continue treatment with antiepileptic drugs (AEDs) for many years after epilepsy surgery despite seizure freedom. In this study, we aimed to investigate why AED treatment is maintained in patients three and seven years after successful epilepsy surgery. To our knowledge, an analysis of this specific subgroup of completely seizure-free patients has not been done before. MATERIAL AND METHODS: Danish patients with medically refractory epilepsy and histopathologically proven hippocampal sclerosis operated between 1995 and 2014 who were reported seizure-free at one-year postsurgery were contacted by telephone in 2017 and retrospectively asked about the reasons to continue or taper AED at three and seven years after the operation. RESULTS: Fifty patients were completely seizure-free three years after the operation. Of those, 31 (62%) were still taking AEDs at three years, thereof 10 (20%) in the same dose and number and half of those on their own wish. At seven years, nine patients were still taking AEDs, two in unchanged number and dose, both on their own wish. Fear of relapse was the most common reason not to withdraw medication. Presurgery seizure frequency for patients taking AEDs at three and seven years was not higher than for those who had discontinued taking AEDs. CONCLUSIONS: A large portion of completely seizure-free patients still take AEDs even seven years after epilepsy surgery. This seems to be largely due to the patients' own wishes and fear of relapse, and unrelated to presurgery seizure frequency. Our results could aid in counseling patients on the decision to withdraw AEDs after successful epilepsy surgery.

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention.

Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I-V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient's symptoms, especially patients diagnosed with "far out syndrome" treated with laminectomy. Clinical outcomes were more heterogenetic for patient's treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient's clinical outcome over time, whereas steroid injection only improves the patient's symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS.