Abstracts

Rationale: The incidence of epilepsy after stroke is reportedly 13 to 33%. In some patients, refractory epileptic seizures occur. In this study, we report on treatment results of 4 patients who underwent surgery for refractory epilepsy after stroke. Methods: The subjects were 4 patients who developed stroke before 2013, and in whom seizure control with drugs was unfavorable. Considering the type of seizure evaluated based on long-term video-electroencephalographic recording, electroencephalographic findings, magnetic resonance imaging (MRI) findings, and clinical course, we performed surgery, and examined its inhibitory effects on postoperative seizures (Engel classification) and the degree of improvement in the quality of life (QOL). Results: Four females required surgery. Ages at the onset of stroke ranged from 14 to 62 years (mean: 40.2 years). Stroke was caused by cerebral hemorrhage from cavernous hemangioma in 1 patient, cerebral hemorrhage from arteriovenous malformation (AVM) in 1, and subarachnoid hemorrhage (SAH) in 2. In 1 of the two patients, cerebral hemorrhage occurred on the side ipsilateral to a ruptured cerebral aneurysm 4 years after the onset of SAH. Ages at the initial seizure ranged from 16 to 63 years (mean: 41.5 years). The type of seizure was evaluated as non-convulsive status epilepticus in 1 patient, complex partial seizure in 3, partial seizure in 1, and secondary generalized seizure in 3. MRI findings included hippocampal sclerosis in 3 patients. Based on detailed examination, 5 sessions of surgical treatment were performed for all 4 patients: focal excision (n=1), amygdalohippocampectomy (n=1), vagus nerve stimulation (VNS) alone (n=1), and amygdalohippocampectomy following VNS due to unfavorable seizure control (n=1). The inhibitory effects of these procedures on postoperative seizures were evaluated as Engel class 1b in 2 patients, 1c in 1, and 2a in 1. In 2 patients who developed epilepsy after SAH and underwent surgery at 60 years or older of age, 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 even in patients aged over 60 years. Funding: Non funding.