OBJECTIVE:We describe postoperative seizure outcomes in a cohort of surgically treated patients with supratentorial intracerebral cavernous malformations (sICMs) and seizures, and identify therapeutic predictors of postoperative seizure freedom.BACKGROUND:Seizures are the most common presenting symptom in patients with sICMs and frequently progress to medically refractory epilepsy. Eliminating the seizure burden in these patients can reduce disability and improve quality of life.DESIGN/METHODS:Patients with sICMs were identified from a radiographic database for cases seen between 1989 and 1999. Clinical and radiographic information was abstracted and prospective follow up was obtained. Postoperative seizure outcome was defined using the Engel classification scheme, with seizure freedom corresponding to Engel Class I.RESULTS:A total of 110 patients with seizures and a radiographic diagnosis of sICMs were identified, 49 (45%) of whom underwent surgical resection of an ICM. The surgical group had 303 patient-years of postoperative follow-up and 96% of patients had follow-up beyond 1 year. Of the surgical group, 32 patients (65%) had a lesionectomy, 19 (59%) of whom were seizure-free. Six patients (12%) had a temporal lobectomy, all of whom achieved seizure freedom. Seven patients (14%) had a temporal lobectomy with amygdalohippocampectomy, 3 (43%) of which were seizure-free. The remaining 4 patients had a combination of the above procedures. At time of last follow up, 75% patients did not have significant disability. Thirty-two patients (65%) in the surgical group achieved seizure freedom, 23 (47%) did not require antiepileptic therapy, and 5 (10%) required a single antiepileptic drug. Four patients (8%) underwent a second surgical procedure due to persistent seizures, none of whom had improvement in seizure outcome.CONCLUSIONS:Nearly two-thirds of patients who underwent surgical resection of an ICM achieved seizure freedom. Nearly half of the surgical cohort did not require long-term antiepileptic therapy. Temporal lobectomies were associated with the highest rate of seizure control.Study Supported by:
Disclosure: Dr. Morparia has nothing to disclose. Dr. Shin has nothing to disclose. Dr. Brown has nothing to disclose. Dr. Christianson has nothing to disclose. Dr. Flemming has nothing to disclose.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P2.101?rss=1
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