Managing Antiepileptic Drug Side Effects After Surgery

Issues with Antiepileptic Medications

Hello Dr.
Yang, my mother-in-law underwent a chronic subdural hematoma drainage surgery in December last year.
After the surgery, she successfully regained consciousness.
She has been taking antiepileptic medication since then, but she has been experiencing side effects such as drowsiness, lethargy, poor appetite, and chest tightness.
I would like to ask if it is possible to discontinue the antiepileptic medication since she is now at home recovering and has no prior history of epilepsy.
Thank you.

Azhong, 50~59 year old female. Ask Date: 2016/01/19

Dr. Yang Shenggong reply Neurology

Hello Mr.
A-Chung, chronic subdural hematoma is one of the many causes of epilepsy, but it does not necessarily occur in every case.
If a neurosurgeon prescribes antiepileptic medications, it is primarily to prevent the occurrence of seizures, as seizures can adversely affect the patient's recovery and can also lead to complications.
If the patient has not experienced any seizures from the onset of the condition to post-surgery, it may be considered to discontinue the medication; however, this decision should be made after a thorough evaluation of the patient's clinical presentation and electroencephalogram (EEG) results by a physician.
Although the incidence is low, there is still a certain risk of seizures occurring after discontinuation of the medication.
Furthermore, if discontinuation of antiepileptic drugs is being considered, it is advisable to taper the dosage gradually, as abruptly stopping a high dose of medication can itself be a trigger for seizures.
If the patient is experiencing side effects, it is recommended to discuss medication adjustments with the physician.
If you are open to it, you may also seek further evaluation from a neurologist at your local hospital.
I hope this answers your questions.
Dr.
Yang Sheng-Gong, Neurology Department, Changhua Hospital.

Reply Date: 2016/01/19

More Info

Managing side effects from antiepileptic drugs (AEDs) after surgery, especially in patients who have not previously had a history of seizures, requires careful consideration and collaboration with healthcare professionals. In the case of your mother, who underwent a chronic subdural hematoma drainage surgery and has been experiencing side effects from her prescribed AEDs, it is essential to approach this situation with a thorough understanding of the risks and benefits involved.

Firstly, it is important to recognize that the use of AEDs post-surgery is often a precautionary measure. The primary goal of administering these medications is to prevent the occurrence of seizures, which can complicate recovery and lead to further neurological damage. In patients who have undergone neurosurgery, the risk of seizures can be heightened due to the trauma and changes in the brain's environment. Therefore, the decision to continue or discontinue AEDs should be made with careful consideration of the patient's clinical history and current condition.

In your mother's case, since she has no prior history of seizures, the healthcare provider may consider tapering off the AEDs if she has been stable and has not exhibited any seizure activity since the surgery. However, this decision should not be made unilaterally. It is crucial to consult with her neurologist or the physician who managed her care during and after the surgery. They can assess her overall health, review her medical history, and potentially conduct an electroencephalogram (EEG) to evaluate her brain activity for any signs of seizure activity.

If the decision is made to discontinue the AEDs, it is generally recommended to do so gradually rather than abruptly. Sudden withdrawal from AEDs can precipitate seizures, particularly in patients who have been on them for an extended period. A gradual tapering schedule allows the brain to adjust to the absence of the medication and minimizes the risk of seizure recurrence.

In addition to the potential for seizures, it is also essential to address the side effects your mother is experiencing, such as drowsiness, lethargy, poor appetite, and chest discomfort. These side effects can significantly impact her quality of life and recovery. If the AEDs are indeed contributing to these symptoms, discussing alternative medications or adjusting the dosage with her healthcare provider may be beneficial. There are several AEDs available, and some may have a more favorable side effect profile for her specific situation.

Moreover, lifestyle modifications can also play a role in managing side effects. Encouraging your mother to maintain a balanced diet, stay hydrated, and engage in light physical activity (as tolerated) can help improve her overall well-being and appetite. Additionally, ensuring she has a supportive environment and access to mental health resources can be beneficial, especially if she is feeling down or anxious about her recovery.

In summary, managing antiepileptic drug side effects after surgery involves a collaborative approach with healthcare professionals, careful monitoring of the patient's condition, and consideration of both the risks of seizure recurrence and the impact of side effects on the patient's quality of life. It is crucial to have open communication with her medical team to ensure that any changes to her medication regimen are safe and appropriate for her recovery.

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