Abstract
Objective
Cerebral cavernous malformations (CCMs) present variably and epileptic seizures are the most common symptom. The factors contributing to cavernoma-related epilepsy (CRE) and drug resistance remain inconclusive. The outcomes of CRE after different treatment modalities have not yet been fully addressed. This study aimed to characterize the clinical features of patients with CRE and the long-term seizure outcomes of medical and surgical treatment strategies.
Methods
This was a retrospective cohort of 135 patients with CCM who were diagnosed in 2007~2011 and followed up for 93.6 months on average. The patients were divided into drug-resistant epilepsy (DRE) (n = 29), non-DRE (NDRE) (n = 45), and no epilepsy (NE) (n = 61).
Results
Temporal CCM was the factor most strongly associated with the development of both CRE and DRE. The majority of patients with single temporal CCMs had CRE (86.8%, n = 33) and 50% had DRE, whereas only 14.7% (n = 5) with a non-temporal supratentorial CCM had DRE (P < 0.05). The most common lesion site in the DRE group was the mesiotemporal lobe (50%). Multiple CCMs were more frequently observed in the CRE (29.2%) than the NE (11.5%) group (P < 0.05). In patients with CRE, multiple lesions were associated with a higher rebleeding rate (odds ratio: 11.1), particularly in those with DRE (odds ratio: 15.4). The majority of patients who underwent resective surgery for DRE (76.5%, n = 13) achieved ILAE class I and II seizure outcomes even after a long disease course.
Significance
Temporal CCM not only predisposes to CRE but is also a major risk factor for drug resistance. The mesiotemporal lobe is the most epileptogenic zone. Multiple CCMs are another risk factor for CRE and increase the rebleeding risk in these patients. Surgical resection could provide beneficial long-term seizure outcomes in patients with DRE.
MAY