해면상 혈관종을 동반한 간질환자의 예후

Abstract

Backgrounds: Since the advent of MRI, cavernous angioma has been recognized as an important cause of chronic epilepsy. However, the natural course or optimal treatment strategies of chronic epilepsy with cavernous angioma have not been established yet. Methods: We conducted a retrospective review of the Yonsei Epilepsy Data Bank and found 13 patients with characteristic MR findings of cavernous angioma who have been followed at the Yonsei Epilepsy Clinics for longer than one year. The clinical variables and outcome of the patients were analyzed. Results : The subjects consisted of 7 men and 6 women. The age of seizure-onset was approximately 21 years old and the duration of seizure were 9 years. All patients in this study had small(< 2cm) and single cavernous angioma and the majority of lesions(9/13) were located in the temporal lobe. One patient also had hippocampal atrophy and another two had combined venous malformations. After adequate trials of antiepileptic drug therapy, 5 patients became seizure free, 2 patients showed worthwhile improvement and the remaining 6 patients did not have any improvement. The withdrawal of antiepileptic drugs was tried in two patients after seizure free period of 3 years but seizure recurred in all patients. Epilepsy surgery had been performed in two patients. One patient who had the left hippocampal atrophy has been remain seizure free after a standard anterior temporal lobectomy but the other patient who had performed a lesionectomy alone did not improve after surgery. During the period of follow up for about 36 months, no symptomatic bleeding had been occurred in any patiet included to the study. Conclusion : The incidence of hemorrhagic events in chronic epilepsy patients with cavernous angioma is extremely low. About half of the patients can be adequately managed by antiepileptic drugs therapy but the chance of successful withdrawal of AEDs seems slim.