Abstracts

Rationale: Cerebral cavernous malformation (CCMs) account for 10% to 15% of all vascular malformations in the central nervous system. Seizures are the presenting symptom in 23% to 50% patients with CCMs. We investigated factors that related with seizure outcome of medically cavernous malformation (CM) patient with adult-onset epilepsy.

Methods: This retrospective observational study included 48 adult-onset focal epilepsy patients with cavernous malformation who visited neurologic department of Asan medical center between January 1989 and December 2018. During their follow up interval, all of them had EEG, Brain MR. These patients had medical treatment longer than 2 years without neurosurgery.
_x000D_ The seizure outcome measure was the terminal 2-year seizure freedom. And we analyzed clinical factors related with seizure outcome. The potential variables were sex, age at seizure onset, the number of seizures before diagnosis, predominant seizure type at diagnosis, maximal diameter of CM, location of CM, epileptiform discharges on EEG and type or number of antiseizure medication. The stepwise logistic regression was performed. Pearson chi-squared test or Fisher exact test were used for univariable analysis and the goodness of fit of a statistical model was measured using the Hosmer–Lemeshow test for multivariable analysis.

Results: Of 48 subjects (58.3% men) included, 31 (64.6%) subjects finally achieved a terminal 2-YSF. After first drug trial, 31 (64.6%) subjects had an initial 2-YSF with 23 (47.9%) patient remaining seizure free until the last follow-up visit. Additional 8 patient gained terminal 2-year seizure free after second and third drug trial. Total 2-year terminal remission was 64.6% of patients (n = 31) with mean seizure free duration of 7.7±4.9 years. The proportion of uncontrolled seizure was 20.8% of patients (n = 10). 2-year terminal remission was more likely gained in the patients with age ≥45 years at seizure onset (odds ratio = 4.260, p = 0.056), an absence of epileptiform discharge on EEG (odds ratio = 0.214, p = 0.047) and extratemporal location of CM, lesser number of seizures before diagnosis. In contrast, uncontrolled seizures were associated with frequent seizures before diagnosis, the patient who presented as focal seizures, temporal location of CM, and presence of epileptiform discharge on EEG.

Conclusions: In our study, 2-year terminal remission was 64.6% of patients (n = 31). It is likely to fail to get 2-year remission in who shows epileptiform discharge on EEG. Less significant but, those who are younger, who visit hospital after many seizures, also the patient whose CM locate in temporal lobe in MR are likely to fail 2 years seizure free. According to this result, the patient who are predicted to fail 2-year remission, earlier surgical management can be considered.

Funding: This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.