Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
<i>Background and Objectives:</i> 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 antiseiz...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/4/785 |
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| author | Yuxin Wu Zaiyu Zhang Ping Liang Lusheng Li Bin Zou Difei Wang Xinyu Dong Haotian Tang Hanli Qiu Xuan Zhai |
| author_facet | Yuxin Wu Zaiyu Zhang Ping Liang Lusheng Li Bin Zou Difei Wang Xinyu Dong Haotian Tang Hanli Qiu Xuan Zhai |
| author_sort | Yuxin Wu |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> 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. <i>Materials and Methods</i>: 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. <i>Results</i>: 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% (<i>n</i> = 23) of patients achieved seizure freedom, 41.3% (<i>n</i> = 26) achieved seizure remission, and 61.9% (<i>n</i> = 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 (<i>p</i> = 0.02), seizure remission (<i>p</i> = 0.02), and a good QoL (<i>p</i> = 0.01). <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-11T04:45:33Z |
| format | Article |
| id | doaj.art-4edf64d51bf740f58756feb4c4d2903d |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T04:45:33Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-4edf64d51bf740f58756feb4c4d2903d2023-11-17T20:22:03ZengMDPI AGMedicina1010-660X1648-91442023-04-0159478510.3390/medicina59040785Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?Yuxin Wu0Zaiyu Zhang1Ping Liang2Lusheng Li3Bin Zou4Difei Wang5Xinyu Dong6Haotian Tang7Hanli Qiu8Xuan Zhai9National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, ChinaNational Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, Chongqing 400015, China<i>Background and Objectives:</i> 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. <i>Materials and Methods</i>: 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. <i>Results</i>: 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% (<i>n</i> = 23) of patients achieved seizure freedom, 41.3% (<i>n</i> = 26) achieved seizure remission, and 61.9% (<i>n</i> = 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 (<i>p</i> = 0.02), seizure remission (<i>p</i> = 0.02), and a good QoL (<i>p</i> = 0.01). <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/59/4/785epilepsyepilepsy surgeryantiepileptic drugsurgery failurequality of life |
| spellingShingle | Yuxin Wu Zaiyu Zhang Ping Liang Lusheng Li Bin Zou Difei Wang Xinyu Dong Haotian Tang Hanli Qiu Xuan Zhai Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes? Medicina epilepsy epilepsy surgery antiepileptic drug surgery failure quality of life |
| 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 | epilepsy epilepsy surgery antiepileptic drug surgery failure quality of life |
| url | https://www.mdpi.com/1648-9144/59/4/785 |
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