BACKGROUND: Multiple cerebral cavernous malformations (mCCMs) are known as potentially epileptogenic lesions. Treatment might be multimodal. Management of patients with mCCMs and epilepsy is challenging.
OBJECTIVE: To evaluate (1) algorhythmic therapeutic sequences in patients with epilepsy associated to mCCMs, (2) whether there are predictive parameters to anticipate the development of drug-resistant epilepsy, and (3) seizure after epilepsy surgery compared to conservatively-treated drug-resistant patients.
METHODS: All inpatients and outpatients with epilepsy associated to mCCMs from 1990 to 2010 and follow-up >12 months available were retrospectively analyzed.
RESULTS: Twenty-three patients matched inclusion criteria. Epilepsy became drug-resistant in 18/23 (78%) patients. No predictors were found for development of drug-resistant epilepsy. Median follow-up for both groups was 7.8 years. Nine patients did not qualify for surgical therapy and were treated conservatively. One patient of this cohort (11%) was seizure-free (International League Against Epilepsy [ILAE] class 1). Surgical treatment was performed in 9 patients; 7/9 (78%) of these patients were seizure-free (ILAE class 1) after epilepsy surgery for at least 12 months compared with 1/9 patients in the non-operated group. In 7/9 cases (78%) the largest CCM was resected. In 8/9 (89%) not all CCMs were resected.
CONCLUSION: After initial diagnosis of epilepsy associated to mCCMs, a primary conservative approach is reasonable. Surgical treatment can be successful in a large fraction of cases with drug-resistant epilepsy where an epileptogenic lesion is identified. Cases where surgery is not undertaken are likely to remain intractable.
ABBREVIATIONS: AED, antiepileptic drug
CCMs, cerebral cavernous malformations
DRE, drug-resistant epilepsy
ILAE, International League Against Epilepsy
mCCMs, multiple cerebral cavernous malformations
*Department of Neurosurgery,
‡Department of Epileptology,
¶Department of Pathology/Neuropathology,
§Department of Radiology, University of Bonn Medical Centre, Bonn, Germany;
‖Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany;
**Department of Neuroradiology, University of Freiburg Medical Center, Freiburg, Germany
Correspondence: Christian von der Brelie, MD, Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany. E-mail: CvdB@gmx.net
Received July 11, 2013
Accepted October 07, 2013