Abstracts

Rationale: The most common cause of adult epilepsy is stroke. The incidence of epilepsy after stroke is reportedly 13 to 33%, and 6.8% of patients suffer from epilepsy for one year. In some patients, intractable seizure occurs. In elderly patients, in 39 to 45% of cases the cause of epilepsy is stroke. In this study, we retrospectively reviewed the treatment results of patients who underwent surgery for refractory epilepsy after stroke. Methods: The subjects were 5 patients who developed stroke before 2016, and in whom seizure control with drugs was unfavorable. Considering the type of seizure, evaluated based on long-term video-electroencephalographic recordings, magnetic resonance imaging (MRI) findings, and clinical course, we performed surgery and examined the postoperative seizure outcome (Engel classification) and the degree of improvement in the QOL. (QOLIE-31-P). Results: Of the 5 patients in this study, the ratio of male to female was 1:4. The age at the onset of stroke ranged from 14 to 62 years (mean: 41 years). Stroke was caused by intracranial hemorrhage (ICH) from cavernous hemangioma in 1, ICH from arteriovenous malformation (AVM) in 1, hypertensive ICH in 1, and subarachnoid hemorrhage (SAH) in 2 patients. The age at the initial seizure ranged from 16 to 63 years (mean: 42 years). The type of seizure was evaluated as non-convulsive status epilepticus in 1, complex partial seizure in 3, partial seizure in 2, and secondary generalized seizure in 4 patients. MRI findings showed hippocampal sclerosis in all the patients. Based on detailed examination, 5 sessions of surgical treatment were performed for all 5 patients: focal excision in 1, amygdalohippocampectomy in 1, vagus nerve stimulation (VNS) alone in 1, and amygdalohippocampectomy following VNS due to unfavorable seizure control in 1 patient. In 1 of the 2 cases of focal excision, in which hypertensive hemorrhage in the posterior part of the left temporal lobe led to hippocampal atrophy, the procedure was performed at the periphery of the lesion in the left extratemporal cortex, based on intracranial electroencephalogram records. The inhibitory effects of these procedures on postoperative seizures were evaluated as Engel class 1a in 1, 1b in 2, 1c in 1, and 2a in 1 patient. In 4 of the 5 patients who underwent surgical treatment, not only seizure prevention but also an improvement in the QOL was confirmed.  Conclusions: The surgical treatment for all patients with epilepsy after stroke exhibits inhibitory effects on seizures. The results suggest that an improvement in the QOL can be achieved after operation. Funding: There was nobody for my support.