Challenges in the Management of Cavernoma-Related Epilepsy: Seizure Outcomes, Antiseizure Medication Practices, and Access to Intraoperative Technologies in Kazakhstan.

OBJECTIVE

This study aims to analyze the diagnostic patterns of cavernoma-related epilepsy, the management of antiseizure medications, and clinical outcomes following microsurgical treatment in patients with late-diagnosed epilepsy secondary to cavernous malformations in the Central Asian region.

METHODS

A retrospective cross-sectional study was conducted on 60 patients who underwent microsurgical resection for brain cavernous malformations over a 12-year period (2010-2022) at the National Centre for Neurosurgery, Astana, Kazakhstan. All participants were 18 years or older and presented with seizures. Follow-up evaluations were conducted by neurologists, and seizure outcomes were assessed using the 2017 classification criteria of the International League Against Epilepsy.

RESULTS

The mean follow-up period was 83.77 ± 39.81 months. In total, 51.67% of participants demonstrated positive ILAE outcomes, 33.33% had moderate ILAE outcomes, and the remaining 15.00% experienced negative ILAE outcomes. Approximately 47% of patients received antiseizure medication before surgery, primarily as monotherapy with carbamazepine (33%), and administered at a low dose (40%). Early microsurgical resection showed a positive post-surgery seizure outcome. Approximately 67% of patients who experienced seizures within one year prior to surgery showed positive ILAE outcomes, whereas those with a seizure history extending beyond five years were roughly 32% seizure-free ( = 0.01).

CONCLUSIONS

Cavernoma-related epilepsy in Central Asia remains a significant clinical challenge, particularly with respect to diagnostic accuracy and antiseizure medication management. In our cohort, only approximately half of patients achieved favorable seizure control following microsurgical resection. Notably, early surgical intervention within one year of seizure onset was associated with improved outcomes, whereas delayed surgery, restricted availability of intraoperative technologies, and suboptimal antiseizure medication practices were linked to less favorable outcomes. Strengthening diagnostic pathways, antiseizure medication management, and expanding access to advanced surgical technologies are critical steps to improving treatment outcomes in a studied patient population.