Factors associated with epileptic seizure of cavernous malformations in the central nervous system in West China

Objective: To explore the factors associated with preoperative and postoperative epileptic seizure in patients with cavernous malformations (CMs).

Methods: A total of 52 consecutive patients from January 2009 to June 2011 who underwent surgical treatment in West China Hospital of Sichuan University due to CMs and confirmed by histopathology were retrospectively reviewed.Patients were divided into two groups (epilepsy-group and non-epilepsy group) according to clinical presentation. Other clinical data, treatment procedure, and follow-up information were collected. Engel classification was used to evaluate seizure outcome.

Results: Low birth weight, temporal lobe involvement and cortical lesion showed significant difference between two groups (p=0.017, 0.003 and 0.025 respectively). Cortical lesion highly increased risk for preoperative epileptic seizure (OR=10.48; 95% CI 1.61-68.23). After a mean follow-up of 2.1 years, 77.8% of epileptic patients achieved Engel class I. Temporal lobe involvement, lesion size < 2.5cm and surgery within one year of symptom onset were found associated with better seizure outcome (p=0.016, 0.012 and 0.050). Temporal lobe involvement significantly decreased the risk for postoperative epileptic seizure (OR=0.038; 95% CI 0.002-0.833). Application of ECoG made no significant difference to seizure outcome (p=0.430). Most patients need continuing medication therapy after surgery.

Conclusion: Surgical treatment of patient with CMs is satisfactory in most cases and temporal lobe involvement usually predict favourable postoperative seizure outcome whether under the monitoring of ECoG or not. Thus, epileptic patients with CMs should be considered for surgical treatment especially when cortical brain layer or temporal lobe was involved.