Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery

In order to identify the current practices of antiepileptic drug (AED) withdrawal after epilepsy surgery, a survey was administered to 204 adult and pediatric epileptologists. The responses from 58 epileptologists revealed wide variations regarding the time course and extent of AED withdrawal after successful epilepsy surgery. For most of the epileptologists, the likelihood of the surgery being successful is an important factor in determining whether or not AEDs are tapered. Most of the respondents started to taper AEDs more rapidly than suggested by previous reports. The majority of the epileptologists were able to stop all AEDs completely in a substantial number of patients. The most important factors considered when deciding to taper AEDs were the presence of ongoing auras and the occurrence of postoperative seizures prior to seizure remission. In the absence of data from well-designed prospective trials, such survey results can inform practice and, hopefully, aid in the design of future trials.

► There are wide variations regarding AED withdrawal after successful epilepsy surgery.
► Patients with mesial temporal sclerosis are more likely to have their AEDs tapered.
► The majority of the epileptologists initiate an AED taper at 6 months after surgery.
► Presence of ongoing auras is an important factor when deciding to withdraw AEDs.
► Occurrence of postoperative seizures prior to remission is the second most important factor.