Abstract：
OBJECTIVE: The timing of antiseizure medication (ASM) withdrawal in children after epilepsy surgery remains controversial and lacks recognized standards. Given the various negative effects of ASM on development in children, this study aimed to evaluate the safety and feasibility of early ASM withdrawal after epileptic resection surgery.
METHODS: We retrospectively assessed the seizure outcomes and ASM profiles of children who had undergone epileptic resection surgery between August 2015 and August 2020 and attempted ASM reduction in the early postoperative phase. Tapering the dose of ASM was attempted when children were seizure-free with no interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) for at least 6 months postoperatively.
RESULTS: This study included 145 children with a median follow-up duration of 40 months. Early ASM tapering was attempted postoperatively in 99 (68.3 %) children. Postoperative ASM discontinuation was attempted in 87 (60.0 %) children. Nine (9.1 %) children experienced seizure recurrence during the ASM reduction stage, and 10 (11.5 %) experienced recurrence after ASM discontinuation. Incomplete resection (P = 0.003) and postoperative seizures before ASM tapering (P = 0.003) were independent predictors of seizure recurrence during and after early ASM withdrawal.
CONCLUSIONS: ASM withdrawal is viable and safe to be initiated in children who are seizure-free postoperatively and have no IEDs on the scalp EEG for at least 6 months. Children with incomplete resection and postoperative seizures before ASM withdrawal are at a higher risk of seizure recurrence and may need to continue ASM for a longer period.
METHODS: We retrospectively assessed the seizure outcomes and ASM profiles of children who had undergone epileptic resection surgery between August 2015 and August 2020 and attempted ASM reduction in the early postoperative phase. Tapering the dose of ASM was attempted when children were seizure-free with no interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) for at least 6 months postoperatively.
RESULTS: This study included 145 children with a median follow-up duration of 40 months. Early ASM tapering was attempted postoperatively in 99 (68.3 %) children. Postoperative ASM discontinuation was attempted in 87 (60.0 %) children. Nine (9.1 %) children experienced seizure recurrence during the ASM reduction stage, and 10 (11.5 %) experienced recurrence after ASM discontinuation. Incomplete resection (P = 0.003) and postoperative seizures before ASM tapering (P = 0.003) were independent predictors of seizure recurrence during and after early ASM withdrawal.
CONCLUSIONS: ASM withdrawal is viable and safe to be initiated in children who are seizure-free postoperatively and have no IEDs on the scalp EEG for at least 6 months. Children with incomplete resection and postoperative seizures before ASM withdrawal are at a higher risk of seizure recurrence and may need to continue ASM for a longer period.
摘要：
目的：儿童癫痫手术后停用抗癫痫药物（ASM）的时间仍然存在争议，缺乏公认的标准。鉴于ASM对儿童发育的各种负面影响，本研究旨在评估癫痫切除术后早期停用ASM的安全性和可行性。
方法：我们回顾性评估了2015年8月至2020年8月期间接受癫痫切除手术并在术后早期尝试减少ASM的儿童的癫痫发作结局和ASM特征。当儿童在术后至少6个月的脑电图（EEG）上没有发作间癫痫样放电（IED）时，尝试降低ASM的剂量。
结果：这项研究包括145名儿童，中位随访时间为40个月。99名（68.3％）儿童在术后尝试早期ASM逐渐减少。87例（60.0％）儿童尝试术后停止ASM。9名（9.1％）儿童在ASM减少阶段经历了癫痫发作复发，10例(11.5%)ASM停药后复发。不完全切除（P=0.003）和ASM逐渐消退前的术后癫痫发作（P=0.003）是ASM早期停药期间和术后癫痫发作复发的独立预测因素。
结论：ASM戒断对于术后无癫痫发作且头皮脑电图至少6个月无IED的儿童是可行且安全的。ASM停药前不完全切除和术后癫痫发作的儿童癫痫发作复发的风险较高，可能需要继续ASM治疗更长的时间。
方法：我们回顾性评估了2015年8月至2020年8月期间接受癫痫切除手术并在术后早期尝试减少ASM的儿童的癫痫发作结局和ASM特征。当儿童在术后至少6个月的脑电图（EEG）上没有发作间癫痫样放电（IED）时，尝试降低ASM的剂量。
结果：这项研究包括145名儿童，中位随访时间为40个月。99名（68.3％）儿童在术后尝试早期ASM逐渐减少。87例（60.0％）儿童尝试术后停止ASM。9名（9.1％）儿童在ASM减少阶段经历了癫痫发作复发，10例(11.5%)ASM停药后复发。不完全切除（P=0.003）和ASM逐渐消退前的术后癫痫发作（P=0.003）是ASM早期停药期间和术后癫痫发作复发的独立预测因素。
结论：ASM戒断对于术后无癫痫发作且头皮脑电图至少6个月无IED的儿童是可行且安全的。ASM停药前不完全切除和术后癫痫发作的儿童癫痫发作复发的风险较高，可能需要继续ASM治疗更长的时间。
