{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:42:29Z","timestamp":1792226549769,"version":"4.4.0"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether postoperative reduction of anti\u2010seizure medication (ASM) burden is associated with cognitive improvement after anterior temporal lobectomy (ATL) in seizure\u2010free patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed data for adult patients with drug\u2010resistant 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\u2009year. ASM burden was quantified using the prescribed daily dose\/defined daily dose ratio, and the reduction rate was calculated. Preoperative and 1\u2010year postoperative neuropsychological outcomes, including full\u2010scale intelligence quotient (FSIQ) and domain\u2010specific 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\u2013response relationships were assessed via sensitivity analyses, analysis of covariance (ANCOVA), and categorical modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010seven seizure\u2010free patients were included in the primary analysis (median age at surgery, 32\u2009years; 33 female). Greater ASM reduction was significantly associated with improved working memory (WM) (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009.066,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.001). A positive but non\u2010significant trend was observed for FSIQ (\n                      <jats:italic>\u03b2\u2009<\/jats:italic>\n                      =\u2009.021,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.062). A dose\u2013response relationship was identified, with greater ASM reduction associated with progressively greater improvement in WM (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.013). Findings were consistent across sensitivity and ANCOVA analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Postoperative ASM reduction was associated with domain\u2010specific cognitive improvement following ATL, particularly in WM. These findings support ASM tapering as a potentially modifiable factor influencing postoperative cognitive outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70395","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:24:47Z","timestamp":1784553887000},"page":"5255-5263","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative reduction of anti\u2010seizure medication is associated with cognitive improvement in seizure\u2010free patients after anterior temporal lobectomy"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8124-915X","authenticated-orcid":false,"given":"Kazushi","family":"Ukishiro","sequence":"first","affiliation":[{"name":"Department of Epileptology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8794-1740","authenticated-orcid":false,"given":"Shin\u2010ichiro","family":"Osawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5860-5016","authenticated-orcid":false,"given":"Maimi","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Epileptology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8948-6205","authenticated-orcid":false,"given":"Makoto","family":"Ishida","sequence":"additional","affiliation":[{"name":"Department of Epileptology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-9679","authenticated-orcid":false,"given":"Takafumi","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Epileptology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"},{"name":"Department of Neurology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0535-496X","authenticated-orcid":false,"given":"Kazutoshi","family":"Konomatsu","sequence":"additional","affiliation":[{"name":"Department of Epileptology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"},{"name":"Department of Neurology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1472-6032","authenticated-orcid":false,"given":"Hidenori","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-6478","authenticated-orcid":false,"given":"Kazutaka","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Epileptology Tohoku University Graduate School of Medicine  Sendai Miyagi 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