Seizures and Epilepsy in Patients With Untreated Cerebral Cavernous Malformations

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND AND OBJECTIVES: Treatment decisions for patients with epileptic seizures due to cerebral cavernous malformations (CCMs) are challenging because of a paucity of studies. We aimed to assess the rates and risk factors of CCM-related seizures during long-term follow-up without CCM intervention. METHODS: This population-based study included people aged 16 years or older in Scotland who were newly diagnosed with CCM during 1999-2003 or 2006-2010, using brain MRI or pathology. From the initial presentation that led to CCM diagnosis, during prospective follow-up without CCM intervention, we analyzed the rates and risk factors for epileptic seizure(s) after any presentation, a first-ever epileptic seizure, seizure recurrence after a first unprovoked epileptic seizure, and 2-year/5-year seizure freedom among patients with CCM-related epilepsy (CRE). Among 110 patients who had CRE at initial presentation or developed CRE during follow-up, 82% (95% CI 74%-91%) became 2-year seizure-free and 62% (95% CI 51%-72%) 5-year seizure-free at 10 years, mostly while on antiseizure medicine monotherapy (44/75 [59%] and 40/60 [67%], respectively). DISCUSSION: The risk of a first-ever epileptic seizure from CCM is low. Four of 5 patients who experience a first unprovoked epileptic seizure develop a recurrent seizure within 10 years, justifying diagnosis of CRE after a first unprovoked epileptic seizure due to CCM. Most of the patients with CRE achieve 2-year/5-year seizure freedom within 10 years. These long-term findings can inform patients and guide clinical practice.