A study identified several predictors of seizure freedom in patients with mesial temporal lobe epilepsy (MTLE) following anterior temporal lobectomy (ATL). The findings were published in Neurosciences. Researchers sought to assess the role of magnetic resonance imaging (MRI) brain findings on the timing of antiepileptic drugs (AEDs) withdrawal following anterior temporal lobectomy (ATL) in patients with mesial temporal lobe epilepsy (MTLE).
In this retrospective study, which took place from Jan. 2004 to Dec. 2017, researchers assessed 64 patients with MTLE who underwent ATL and had a minimum of two years of follow-up. They analyzed the correlation between the time required to tapering and eventually discontinuing the use of antiepileptic drugs (AEDs) in ATL and analyzed magnetic resonance imaging (MRI) scans.
According to the results, abnormal brain MRI was observed in 83% patients, suggesting that mesial temporal sclerosis (MTS) accounted for three quarters of these abnormalities. The presence of any MRI abnormality was associated with a 10-month earlier tapering of AEDs (p<0.01), and an 18-month earlier complete withdrawal of AEDs (p<0.01), the researchers noted. They found that the odds of being seizure-free within the first year were higher if MTS was present in the brain MRI (adjusted OR=16). Overall, the presence of unilateral temporal IEDs on preoperative EEG were associated with quicker tapering and discontinuation of AEDs as well as a seizure-free state after ATL surgery.
“Patients with abnormal MRI findings and unilateral IEDs had earlier tapering of AEDs with an overall shorter AED discontinuation plan,” the researchers concluded. “Moreover, the presence of MTS on MRI, along with unilateral IEDs, were predictors of seizure freedom following ATL.”
Keywords: antiepileptic drugs, anterior temporal lobectomy, temporal lobe epilepsy