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Factors Affecting Seizure Outcomes After Surgery for Cavernoma Related Epilepsy.

AIM
Cerebral cavernous malformations (CCM) are the second most common type of vascular malformations and also regarded as highly epileptogenic lesions if they involve the cortex. We present one of the largest retrospective cavernoma related epilepsy (CRE) studies which include divergent supratentorial locations operated and followed up at least 2 years. We also investigated the factors affecting the seizure outcome.


MATERIAL AND METHODS
This study includes 56 patients with drug-responsive (40) and drug-resistant (16) CRE who underwent resective surgery. Age at seizure onset, age at surgery, gender, duration of epilepsy, seizure frequencies/type before and after treatment, EEG and brain MRI findings, prescribed AEDs, preoperative and post-operative neurological status, histopathological diagnosis, post-operative seizure outcomes and surgical information were documented.


RESULTS
The average follow-up period was 69.6 months (range 24-216 months). The seizure outcome was assessed according to Engel's classification at the last follow-up. Engel class I was achieved in 53 patients (95%); there was one patient at class II and two patients at class III. All patients in the drug-responsive group were at Engel class I after the surgery, while all patients at Engel classes II and III were in the drug-resistant patient group. This clearly shows that there were better outcomes in DRP group (p 0.01). Neither the locations of cavernomas nor the duration of epilepsy had any impact on seizure outcome (p 0.05).


CONCLUSION
An earlier surgical intervention may prevent the patients from becoming drug-resistant such that their chances of being seizure free after surgery increase.