gms | German Medical Science

Objective: To assess seizure outcome and successful discontinuation of AED in patients with probable or definite CCM-related epilepsy (CRE) undergoing surgical treatment in the context of etiology-specific management of epilepsy.

Method: Our CCM data base (2003–13) was searched to identify patients:

1.

undergoing surgery for CCM,

2.

suffering from single or multiple seizures,

3.

either medically controled or drug resistent.

Assessment of epilepsy and definition of CRE was based on the recommendations of the surgical task force of the ILAE. Further CCM assessment was based on the reporting standards of CCM research. Patients were followed up to assess seizure outcome (Engel classfication, ILAE classification), functional outcome (mRS) and successful discontinuation of AED.

Results: 69 patients (mean age 37.8 ± 16.1) matched the inclusion criteria. Mean follow-up was 53 months (range 12–150 months). 14 showed drug resistent seizures (DRS), 20 presented with history of multiple seizures (MS), 35 with history of single new-onset seizure (SNOS). In 16 patients seizures were focal only, in 53 (secondary) generalized. 23 CCM were located strictly temporal, 46 extratemporal. CCM size was 17 ± 6.8 mm. Duration of epilepsy was >1 year in 23 and <1 year in 46 patients. Based on mRS operative morbidity was 19% at discharge, 6% at 6 months follow-up and 3% at last follow-up. At last follow-up 48 patients were Engel class IA, 15 Engel class IB-D, 2 Engel class II and 1 Engel class IVB. Patients with DRS were completely seizure free in 42%, patients with MS or SNOS in 80%. In patients with DRS AED were discontinued in 35%, in patients with MS or SNOS in 70%, respectively. Outcome predictors were duration of epilepsy, location of CCM and CCM MRI appearance.

Conclusions: The indication for surgical treatment of CCM is based on various parameters. Beside neurological symptoms, estimated (re-)bleeding risk, size and location of CCM, as well as general medical condition of the patient, the control of CRE has to be considered. Overall, our results compete with outcome and side-effects of "conservative" therapy with AED. In particular, they are helpful in balancing treatment decisions for patients in which "early surgery" (MS + SNOS) can be considered: those with high risk of CCM bleeding, uncompliance in, or the desire to stop, AED treatment (ILAE recommendations).