Postoperative reduction of anti-seizure medication is associated with cognitive improvement in seizure-free patients after anterior temporal lobectomy.
Postoperative ASM reduction was associated with domain-specific cognitive improvement following ATL, particularly in WM, which support ASM tapering as a potentially modifiable factor influencing postoperative cognitive outcomes.
Abstract
Objective
To determine whether postoperative reduction of anti-seizure medication (ASM) burden is associated with cognitive improvement after anterior temporal lobectomy (ATL) in seizure-free patients.
Methods
We retrospectively analyzed data for adult patients with drug-resistant temporal lobe epilepsy who underwent unilateral ATL between March 2013 and January 2025. Analyses were restricted to patients achieving complete freedom from seizures (Engel Class I) at 1 year. ASM burden was quantified using the prescribed daily dose/defined daily dose ratio, and the reduction rate was calculated. Preoperative and 1-year postoperative neuropsychological outcomes, including full-scale intelligence quotient (FSIQ) and domain-specific indices, were assessed. The effect of ASM reduction on cognitive change was evaluated using a doubly robust estimation framework integrating inverse probability of treatment weighting with multivariable outcome regression. Robustness and potential dose-response relationships were assessed via sensitivity analyses, analysis of covariance (ANCOVA), and categorical modeling.
Results
Fifty-seven seizure-free patients were included in the primary analysis (median age at surgery, 32 years; 33 female). Greater ASM reduction was significantly associated with improved working memory (WM) (β = .066, p = .001). A positive but non-significant trend was observed for FSIQ (β = .021, p = .062). A dose-response relationship was identified, with greater ASM reduction associated with progressively greater improvement in WM (p = .013). Findings were consistent across sensitivity and ANCOVA analyses.
Significance
Postoperative ASM reduction was associated with domain-specific cognitive improvement following ATL, particularly in WM. These findings support ASM tapering as a potentially modifiable factor influencing postoperative cognitive outcomes.
Palliative surgical procedures for pediatric DRE are safe and associated with seizure reduction, decreased medication burden, and gradual improvement in adaptive functioning and early surgical intervention may help minimize developmental decline and improve long-term adaptive outcomes.
Ana Valeria Duarte Oliveira, H. Machado, Ú. Thomé et al.· Child's Nervous System· 0 citations
OBJECTIVE
To assess whether postoperative residual seizure burden may provide patient-centered information beyond relative seizure improvement by examining willingness to undergo vagus nerve stimulation (VNS) again in drug-resistant epilepsy (DRE).
METHODS
This single-center cross-sectional study included patients with DRE after VNS implantation. Baseline data were retrieved from an institutional database, and follow-up data were collected using a structured questionnaire. The primary outcome was willingness to undergo VNS again, treated as an exploratory decision-centered patient-reported measure and analyzed as yes versus no/uncertain. Subjective seizure improvement, quality-of-life (QoL) improvement, overall satisfaction, willingness to recommend VNS, and adverse effects were also assessed. Seizure burden before and after VNS was graded using broad frequency-based categories. Category improvement reflected relative improvement, whereas postoperative residual burden reflected the absolute burden remaining after treatment.
RESULTS
Of 58 screened patients, 54 were included. Overall, 32/54 (59.3%) would undergo VNS again, 22/54 (40.7%) were satisfied, and 25/54 (46.3%) would recommend VNS. Subjective seizure improvement and QoL improvement were reported by 35/54 (64.8%) and 33/54 (61.1%) patients, respectively. Seizure burden category improved in 35/54 (64.8%), but 11/54 (20.4%) continued to have daily seizures after VNS. Patients willing to undergo VNS again were more likely than those unwilling or uncertain to report subjective seizure improvement (87.5% vs 31.8%, P < 0.001), QoL improvement (90.6% vs 18.2%, P < 0.001), and seizure burden category improvement (81.2% vs 40.9%, P = 0.004). They also had lower postoperative residual seizure burden (median category 1.0 [IQR 0.0-2.3] vs 3.0 [IQR 2.0-4.0], P < 0.001).
CONCLUSIONS
Willingness to undergo VNS again was associated with relative improvement and lower postoperative residual seizure burden. These findings suggest that residual seizure burden may provide complementary patient-centered information when interpreted alongside conventional response measures and established patient-reported outcomes.
Xinjie Wang, Liang Qiao· Journal of clinical neurosci...· 0 citations
OBJECTIVE
Given the reciprocal interaction between tumor biology and seizure activity, seizure outcomes in low-grade glioma (LGG) may be dynamic and influenced by both tumor- and treatment-related factors. We aimed to identify factors associated with seizure occurrence across distinct clinical stages, including diagnosis, surgery, long-term follow-up, and antiseizure medication (ASM) withdrawal.
METHODS
We retrospectively analyzed patients with World Health Organization grade 1-2 glioma who underwent surgery between January 2001 and February 2025 and experienced seizures during their disease course. Clinical, radiological, molecular, and treatment-related variables, along with longitudinal seizure data, were collected. Seizure outcomes were evaluated at 6 and 12 months and at final follow-up, including time to postoperative seizure recurrence and recurrence after ASM withdrawal.
RESULTS
Among 100 patients (mean postoperative follow-up = 89.9 months), 70.0% achieved seizure freedom during the final year of follow-up. At 6 months, gross total resection (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.19-10.01, p = .02) and preoperative tumor volume (OR = .99, 95% CI = .97-1.00, p = .048) were independently associated with seizure outcomes. At 12 months, preoperative tumor volume (OR = .99, 95% CI = .98-1.00, p = .04) was significant. Conversely, seizure at presentation was the sole independent determinant of favorable long-term seizure outcome (OR = 6.37, 95% CI = 2.07-19.61, p < .01) and the only predictor of reduced postoperative seizure recurrence in survival analysis (hazard ratio = .26, 95% CI = .11-.62, p < .01). ASM withdrawal was successful in 67.7%. Although tumor progression showed a trend toward an association with recurrence in univariate analyses, no independent predictors were identified in Cox regression for ASM withdrawal outcomes.
SIGNIFICANCE
This time-resolved analysis suggests that early seizure control is primarily influenced by surgical and tumor burden-related factors, whereas long-term seizure outcomes and recurrence appear to be predominantly determined by the clinical presentation at diagnosis rather than treatment-related variables. These findings suggest that postoperative seizure prognosis in LGG reflects pre-existing epileptogenic vulnerability and may not be adequately captured by single time point assessments.
Kyung-Il Park, Chul-Kee Park, Soon-Tae Lee et al.· Epilepsia· 0 citations
OBJECTIVE
Epilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery; however, an analogous effect in palliative procedures has not been shown. We reviewed the Pediatric Epilepsy Surgery Database data for an association between epilepsy duration and seizure reduction in palliative procedures.
METHODS
Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered at 6-12 months and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure.
RESULTS
A total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures.
SIGNIFICANCE
We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.
Robert M Crutcher, David E. Horvat, A. Caraway et al.· Epilepsia· 0 citations
High-frequency IEDs on early postoperative EEG may identify patients at increased risk of long-term deterioration after surgery for HS-related TLE, and prospective studies are needed before modifying routine follow-up strategies.
Kate Durbano, Q. Calonge, Valerio Frazzini et al.· Seizure· 0 citations
Epilepsy surgery preserved intellectual functioning, particularly in FL and PC procedures, however, persistent VCI decline in H and TL groups suggests effects on verbal abilities associated with temporal lobe involvement, and group-level trajectories rather than individual outcomes.
Geisa de Angelis, L. E. Lopes-Santos, D. Aragon et al.· Epilepsia· 0 citations
