Seizure outcome in patients with cavernous malformation after early surgery

Manish Kapadia, Marianne Walwema, Timothy R. Smith, Irena Bellinski, Hunt Batjer, Christopher Getch, Joshua M. Rosenow, Bernard R. Bendok, Stephan U. Schuele

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To describe seizure outcome and complications in patients with cavernous malformations (CM) undergoing early versus late surgery. Methods: A database was created for all CM patients who presented with seizure referred to the neurosurgical clinic at an academic center. A telephone survey and chart review were conducted to evaluate for preoperative and postoperative seizure frequency. Postoperative seizure-free outcome of patients who had ≤2 preoperative seizures versus those that had >2 preoperative seizures was compared. Results: A total of 35 CM patients were included for analysis. Nineteen patients had ≤2 preoperative seizures and 16 patients had >2 preoperative seizures, six of them drug resistant for over two years. Among the ≤2 seizure group, 15 had only a single seizure before surgical resection. 94.7% of patients with ≤2 preoperative seizures and 62.5% of patients with >2 preoperative seizures were seizure free one year following surgical resection (p = 0.019). 78.9% of patients with ≤2 preoperative seizures and 25% of patients with >2 preoperative seizures were able to wean off AEDs (p < 0.001). Among those patients who had a single preoperative seizure, 100% of patients were seizure free at one year. Conclusions: Early surgical resection for CM patients who present after a CM-related seizure is an effective, well tolerated treatment and has good chance to offer seizure freedom without the need for long-term antiepileptic medications. Outcome for patients operated with only one or two preoperative seizures may lead to better results than patients who delay the procedure.

Original languageEnglish (US)
Article number107662
JournalEpilepsy and Behavior
Volume115
DOIs
StatePublished - Feb 2021

Keywords

  • Cavernoma
  • Cavernous malformation
  • Epilepsy surgery
  • First seizure
  • Intractable epilepsy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

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