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67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

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Outcome after conservative management or surgical treatment for new onset epilepsy in CCM

Meeting Abstract

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  • Philipp Dammann - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Germany
  • Yuan Zhu - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Germany
  • Oliver Müller - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Germany
  • Felix Rosenow - Epilepsy Center Franfurt Rhein-Main, Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen - Marburg, Department of Neurology, Philipps-University, Marburg, Germany
  • Ulrich Sure - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.18.04

doi: 10.3205/16dgnc208, urn:nbn:de:0183-16dgnc2082

Veröffentlicht: 8. Juni 2016

© 2016 Dammann et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

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Objective: To determine seizure outcome, functional outcome and the withdrawal of AEDs after either conservative or surgical treatment of patients with new-onset cavernoma related epilepsy (CRE).

Method: We conducted a comparative observational study (n=79) of consecutive patients with a single, sporadic cerebral cavernous malformation (CCM) and new onset CRE.

Results: 41 patients underwent initial surgery (IS), 38 patients initial conservative treatment (IC). Of those, 19 underwent delayed surgical treatment (DS). At the last follow-up these patients were seizure free (ILAE 1) for at least 2 years in 88%, 32% and 79%, respectively (IS vs. IC p<0.0001), and off AED in 78%, 13% and 58%, respectively (IS vs. IC p<0.001). Cumulative probability of staying seizure-free (ILAE 1a) during a 5-year period was 73% (mean seizure free follow-up 49.8±2.7 months, 95% CI 44.4-55.1 months) for the IS group, 22% (mean seizure free follow-up 31.8±3.6 months, 95% CI 24.8-38.8 months) for the IC group and 68% (mean seizure free follow-up 48.6±4.3 months, 95% CI 40.1-57.1 months) for the DS group (IS vs. IC p<0.0001). Operative morbidity was 3%. Morbidity in the conservative group was equally 3%.

Conclusions: Patients with CCM and a new onset CRE that underwent initial surgical treatment showed better results in seizure control and discontinuation of AED compared to conservatively treated patients. Operative morbidity was comparable to morbidity by symptomatic CCM haemorrhage in the conservative group. Half of patients that started with conservative treatment underwent subsequent surgical treatment. However, longer duration of epilepsy prior to surgery did not worsen postoperative seizure outcome.