Management of Anti-seizure Medication in Patients with Drug-resistant Focal Epilepsy Secondary to Focal Cortical Dysplasia Undergoing Epilepsy Surgery in Argentina
Maria Burbano1, Lucia Belen Varela1, Andres Mateos5, Yandri Garcia1, Francisco Abril1, Gabriela Besocke1, Juan Carlos Avalos1, Barbara Rosso1, Walter Silva4, Silvia Christiansen2, Carlos Ciraolo3, Maria del Carmen Garcia1
1Neurology, 2Anatomopathology, 3Neurosurgery, Hospital Italiano de Buenos Aires, 4Hospital Italiano de Buenos Aires, 5Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)
Objective:
Analyze the postoperative management of ASM in a cohort of patients with focal cortical dysplasia (FCD) in the following 10 years after surgery.
Background:
There is no consensus on managing anti-seizure medication (ASM) after successful epilepsy surgery.
Design/Methods:
Retrospective study of patients ≥18 years with a diagnosis of drug-resistant epilepsy secondary to FCD who underwent epilepsy surgery between 2008-2022. The outcome was analyzed according to the Engel Scale and changes in ASM at 1, 2, 5, and 10 years. Statistical analysis was performed in R4.2.0, considering a p-value <0.05 significant.
Results:
Sixty patients were included, mean age at surgery was 38.03 years (range: 19-68). Mean time of disease evolution was 21.33 years.
The year following surgery, ASM usage began to decline. Patients used a mean of 1.91 ASM in the first year (SD 0.87), 1.62 (SD 0.97) at two years, 1.55 (SD 1.27) at five years, and 1.3 (SD 1.26) at ten years. The decrease was statistically significant (T-student (226) = -4.601, p-value < 0.00001) over the years. The model predicts a mean reduction of 0.12 ASM each year since surgery.
Patients with Engel 1 and patients who discontinued ASM over the years were: first year: 71.93% (41/57) / 1.75% (1/57); at 5 years: 71.05% (27/38) / 23.68% (9/38); at 10 years, 75% (15/20) / 40% (8/20). The increase in drug-free patients was statistically significant over the years (p-value<0.0001).
Conclusions:
In our study, the percentage of seizure-free patients after surgery remained constant at 1, 2, 5, and 10 years. A statistically significant decrease in the number of ASM used throughout the follow-up was observed as well as an increase in drug-free patients.