Department of Neurology, Northwestern University Feinberg School of Medicine, United States.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, United States.
Epilepsy Behav. 2021 Feb;115:107662. doi: 10.1016/j.yebeh.2020.107662. Epub 2020 Dec 15.
To describe seizure outcome and complications in patients with cavernous malformations (CM) undergoing early versus late surgery.
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.
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.
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.
描述接受早期与晚期手术的海绵状血管畸形（CM）患者的癫痫发作结局和并发症。
为所有因癫痫发作而就诊于学术中心神经外科诊所的 CM 患者创建了一个数据库。通过电话调查和病历回顾评估术前和术后的癫痫发作频率。比较术前癫痫发作次数≤2 次和>2 次的患者的术后无癫痫发作结果。
共纳入 35 例 CM 患者进行分析。19 例患者术前癫痫发作次数≤2 次，16 例患者>2 次，其中 6 例为难治性癫痫，超过两年。在≤2 次癫痫发作组中，15 例患者在手术切除前仅有一次癫痫发作。手术切除后一年，≤2 次术前癫痫发作的患者中 94.7%无癫痫发作，>2 次术前癫痫发作的患者中 62.5%无癫痫发作（p=0.019）。≤2 次术前癫痫发作的患者中 78.9%和>2 次术前癫痫发作的患者中 25%能够停止使用抗癫痫药物（p<0.001）。在那些术前仅有一次癫痫发作的患者中，100%的患者在一年时无癫痫发作。
CM 相关性癫痫发作后就诊的 CM 患者进行早期手术切除是一种有效、耐受良好的治疗方法，有很大机会无需长期使用抗癫痫药物即可实现癫痫无发作。与延迟手术的患者相比，仅行一次或两次术前癫痫发作手术的患者的结局可能更好。
