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. 2022 Mar 18;12(3):403.
doi: 10.3390/brainsci12030403.

Earlier Age at Surgery for Brain Cavernous Angioma-Related Epilepsy May Achieve Complete Seizure Freedom without Aid of Anti-Seizure Medication

Ayataka Fujimoto  1   2 , Hideo Enoki  2 , Keisuke Hatano  2 , Keishiro Sato  2 , Tohru Okanishi  2
Affiliations

Earlier Age at Surgery for Brain Cavernous Angioma-Related Epilepsy May Achieve Complete Seizure Freedom without Aid of Anti-Seizure Medication

Ayataka Fujimoto et al. Brain Sci. .

Abstract

Background: The present study hypothesized that some factors may distinguish between patients with a brain cavernous angioma (BCA), who were free from anti-seizure medication (ASM), and patients who still required ASMs postoperatively. The purpose of the study was thus to identify factors associated with ceasing ASMs for patients with drug-resistant epilepsy secondary to BCA, who underwent BCA removal surgery.

Methods: We divided patients into those with drug-resistant epilepsy secondary to BCA who achieved complete seizure freedom without ASMs a year after surgery (No-ASM group) (International League Against Epilepsy (ILAE) classification class I with no epileptiform discharges), and others (ASM group) (ILAE classification ≤ II and/or epileptiform discharges). We statistically compared groups in terms of: (1) age at operation; (2) history of epilepsy; (3) size of BCA; and (4) location of BCA.

Results: Overall, a year after the surgery, the No-ASM group comprised 12 patients (48%), and the ASM group comprised 13 patients (52%). In both multi- and univariate logistic regression analyses, age at BCA removal surgery correlated significantly with the No-ASM group (p = 0.043, p = 0.019), but history of epilepsy did not (p = 0.581, p = 0.585).

Conclusions: Earlier age at surgery for patients with drug-resistant epilepsy is encouraged to achieve complete seizure freedom without the need for ASMs when the cause of epilepsy is BCA.

Keywords: age at surgery; anti-seizure medication; cavernous angioma; early surgery; epilepsy; multifactorial mechanism.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient assignment to No-ASM and ASM groups. Overall, 12 patients satisfied the conditions for inclusion in the no-anti-seizure medication (ASM) group (48%), and 13 patients (52%) (3 patients with clinical seizures and 10 patients with epileptiform discharges without clinical seizures) were assigned to the ASM group a year after surgery.
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