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Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?

Background and Objectives: After failed epilepsy surgery, patients often revert to an antiseizure medication (ASM) ASM regimen, which can be adjusted or optimized in three ways: increasing the dose, alternative therapy, and combination therapy. It is unclear which type of antiseizure medication adju...

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Autores principales: Wu, Yuxin, Zhang, Zaiyu, Liang, Ping, Li, Lusheng, Zou, Bin, Wang, Difei, Dong, Xinyu, Tang, Haotian, Qiu, Hanli, Zhai, Xuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146799/
https://www.ncbi.nlm.nih.gov/pubmed/37109743
http://dx.doi.org/10.3390/medicina59040785
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author Wu, Yuxin
Zhang, Zaiyu
Liang, Ping
Li, Lusheng
Zou, Bin
Wang, Difei
Dong, Xinyu
Tang, Haotian
Qiu, Hanli
Zhai, Xuan
author_facet Wu, Yuxin
Zhang, Zaiyu
Liang, Ping
Li, Lusheng
Zou, Bin
Wang, Difei
Dong, Xinyu
Tang, Haotian
Qiu, Hanli
Zhai, Xuan
author_sort Wu, Yuxin
collection PubMed
description Background and Objectives: After failed epilepsy surgery, patients often revert to an antiseizure medication (ASM) ASM regimen, which can be adjusted or optimized in three ways: increasing the dose, alternative therapy, and combination therapy. It is unclear which type of antiseizure medication adjustment method can improve outcomes. Materials and Methods: Children who underwent failed epileptic resection surgery at the Department of Neurosurgery, Children’s Hospital of Chongqing Medical University between January 2015 and December 2021 were included in this cohort, who were reviewed for whether they underwent adjustment of ASM with increased dose, alternative therapy, or combination therapy. The seizure outcome and quality of life (QoL) were assessed. Two-tailed Fisher exact test and Mann–Whitney U test were used for statistical analysis. Results: Sixty-three children with failed surgery were included for further analysis, with a median follow-up time of 53 months. The median seizure recurrence time was 4 months. At the last follow-up, 36.5% (n = 23) of patients achieved seizure freedom, 41.3% (n = 26) achieved seizure remission, and 61.9% (n = 39) had a good QoL. None of the three types of ASM adjustment improved children’s outcomes, whether considered in terms of seizure-free rate, seizure remission rate, or QoL. Early recurrences were significantly associated with decreased probability of seizure freedom (p = 0.02), seizure remission (p = 0.02), and a good QoL (p = 0.01). Conclusions: Children who underwent failed epilepsy surgery remains some potential for late seizure remission from ASM. Yet adjusting ASM regimen does not increase the probability of seizure remission nor does it improve the QoL. Clinicians should complete evaluations and consider the need for other antiepileptic treatment as soon as possible after surgery failed, especially when dealing with children with an early recurrence.
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spelling pubmed-101467992023-04-29 Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes? Wu, Yuxin Zhang, Zaiyu Liang, Ping Li, Lusheng Zou, Bin Wang, Difei Dong, Xinyu Tang, Haotian Qiu, Hanli Zhai, Xuan Medicina (Kaunas) Article Background and Objectives: After failed epilepsy surgery, patients often revert to an antiseizure medication (ASM) ASM regimen, which can be adjusted or optimized in three ways: increasing the dose, alternative therapy, and combination therapy. It is unclear which type of antiseizure medication adjustment method can improve outcomes. Materials and Methods: Children who underwent failed epileptic resection surgery at the Department of Neurosurgery, Children’s Hospital of Chongqing Medical University between January 2015 and December 2021 were included in this cohort, who were reviewed for whether they underwent adjustment of ASM with increased dose, alternative therapy, or combination therapy. The seizure outcome and quality of life (QoL) were assessed. Two-tailed Fisher exact test and Mann–Whitney U test were used for statistical analysis. Results: Sixty-three children with failed surgery were included for further analysis, with a median follow-up time of 53 months. The median seizure recurrence time was 4 months. At the last follow-up, 36.5% (n = 23) of patients achieved seizure freedom, 41.3% (n = 26) achieved seizure remission, and 61.9% (n = 39) had a good QoL. None of the three types of ASM adjustment improved children’s outcomes, whether considered in terms of seizure-free rate, seizure remission rate, or QoL. Early recurrences were significantly associated with decreased probability of seizure freedom (p = 0.02), seizure remission (p = 0.02), and a good QoL (p = 0.01). Conclusions: Children who underwent failed epilepsy surgery remains some potential for late seizure remission from ASM. Yet adjusting ASM regimen does not increase the probability of seizure remission nor does it improve the QoL. Clinicians should complete evaluations and consider the need for other antiepileptic treatment as soon as possible after surgery failed, especially when dealing with children with an early recurrence. MDPI 2023-04-18 /pmc/articles/PMC10146799/ /pubmed/37109743 http://dx.doi.org/10.3390/medicina59040785 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wu, Yuxin
Zhang, Zaiyu
Liang, Ping
Li, Lusheng
Zou, Bin
Wang, Difei
Dong, Xinyu
Tang, Haotian
Qiu, Hanli
Zhai, Xuan
Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
title Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
title_full Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
title_fullStr Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
title_full_unstemmed Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
title_short Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
title_sort does adjustment of antiseizure medication regimen after failed epilepsy surgery improve outcomes?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146799/
https://www.ncbi.nlm.nih.gov/pubmed/37109743
http://dx.doi.org/10.3390/medicina59040785
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