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

作者全名："Wu, Yuxin; Zhang, Zaiyu; Liang, Ping; Li, Lusheng; Zou, Bin; Wang, Difei; Dong, Xinyu; Tang, Haotian; Qiu, Hanli; Zhai, Xuan"

作者地址："[Wu, Yuxin; Zhang, Zaiyu; Liang, Ping; Li, Lusheng; Zou, Bin; Wang, Difei; Dong, Xinyu; Tang, Haotian; Qiu, Hanli; Zhai, Xuan] Childrens Hosp Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Neurosurg, Minist Educ,Key Lab Child Dev & Disorders,Children, Chongqing 400015, Peoples R China; [Wu, Yuxin; Zhang, Zaiyu; Liang, Ping; Li, Lusheng; Zou, Bin; Wang, Difei; Dong, Xinyu; Tang, Haotian; Qiu, Hanli; Zhai, Xuan] Chongqing Key Lab Translat Med Res Cognit Dev & Le, Chongqing 400015, Peoples R China"

通信作者："Zhai, X (通讯作者)，Childrens Hosp Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Neurosurg, Minist Educ,Key Lab Child Dev & Disorders,Children, Chongqing 400015, Peoples R China.; Zhai, X (通讯作者)，Chongqing Key Lab Translat Med Res Cognit Dev & Le, Chongqing 400015, Peoples R China."

来源：MEDICINA-LITHUANIA

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000977500500001

JCR分区：Q2

影响因子：2.6

年份：2023

卷号：59

期号：4

开始页：　

结束页：　

文献类型：Article

关键词：epilepsy; epilepsy surgery; antiepileptic drug; surgery failure; quality of life

摘要："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."

基金机构："National Natural Science Foundation of China [81971217]; National Clinical Research Center Project, China [NCRC-2019-GP-17]"

基金资助正文："Supported by the National Natural Science Foundation of China (Grant No. 81971217) and National Clinical Research Center Project, China (NCRC-2019-GP-17)."