Abstract Details

Title Outcome in Patients with Cavernous Malformations Operated after a First Seizure

Topic Epilepsy

Presentation(s) P04 - (-)

Poster/Presentation
Number 200

Objective

Background BACKGROUND: Seizures are a common presentation for patients with supratentorial CMs. Patients who present with a first seizure due to a CM have a > 90% risk of developing a second seizure within 1 year (Josephson CB, Neurology 2011). Not infrequently, patients presenting with a single seizure due to a CM opt to undergo surgery. There is little data on post surgical seizure outcome in this population.

Design/Methods DESIGN/METHODS: A database was created based on ICD-9 codes for all patients over a 10 year period with seizures secondary to a supratentorial CMs who underwent resection and had a minimum follow up of one year. We identified 37 patients, 14 presenting after a single seizure. We did a telephone survey to determine their post-op seizure outcome and complications.

Results RESULTS: All 14 patients operated after a single seizure were seizure free (follow-up in years: mean 4.6; median 4; range 1-10). All of them were off medications at time of last follow up. The average time to surgery after the first seizure was 5.7 months. Only one minor surgical complication was seen in a patient had mild post-operative cerebral edema which resolved without any further intervention. Compared to our patient population, patients who defer surgery are at significantly higher risk to develop seizure recurrence (OR - 6.1; p< 0.001; Josephson CB, Neurology 2011).

Conclusions CONCLUSIONS: Surgical resection of CMs is a safe and effective treatment for patients with intractable epilepsy. Our data suggests that surgical resection of a CM in first-time seizure patients may prevent seizure recurrence. While the sample size is small, all of our patients remained seizure free and were off antiepileptic medication. No late recurrences were observed during long-term follow up. CM patients with first-time seizure may benefit from early surgical intervention.

Authors/Disclosures
Manish Kapadia, MD PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Stephen Wanaski, PhD (Paragon Biosciences)	Dr. Wanaski has received personal compensation for serving as an employee of Paragon Biosciences. Dr. Wanaski has or had stock in Paragon Biosciences.Dr. Wanaski has or had stock in Emalex Biosciences.
Jeffrey D. Kennedy, MD (University of California, Davis)	Dr. Kennedy has nothing to disclose.
Elizabeth Gerard, MD (Northwestern University)	Dr. Gerard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Xenon. The institution of Dr. Gerard has received research support from NIH/NINDS. The institution of Dr. Gerard has received research support from Xenon Pharmaceuticals. The institution of an immediate family member of Dr. Gerard has received research support from NIH. The institution of Dr. Gerard has received research support from Eisai, Inc. (via Stanford University). Dr. Gerard has received publishing royalties from a publication relating to health care.
Michael P. Macken, MD, MRCPI (Northwestern Medical Faculty Foundation)	Dr. Macken has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharma. Dr. Macken has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Macken has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for SK LifeSciences. Dr. Macken has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for LivaNova. The institution of Dr. Macken has received research support from LivaNova.
	No disclosure on file
	No disclosure on file
Stephan Schuele, MD, FAAN (Northwestern Memorial Hospital)	Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Monteris. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurelis. Dr. Schuele has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Jazz. Dr. Schuele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neurophysiology. Dr. Schuele has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Thomas Needham. Dr. Schuele has received research support from National Institute of Health.

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