• Christian von der Brelie, Marec von Lehe, Anna Raabe, Pitt Niehusmann, Horst Urbach, Christian Mayer, Christian Erich Elger, and Michael P Malter.
• 1Department of Neurosurgery 2Department of Epileptology 3Department of Pathology/Neuropathology 4Department of Radiology, University of Bonn Medical Centre, Bonn, Germany 5Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany 6Department of Neuroradiology, University of Freiburg Medical Center, Freiburg, Germany.
• Neurosurgery. 2013 Oct 17.

Background:Multiple cerebral cavernous malformations (mCCMs) are known as potentially epileptogenic lesions. Treatment might be multimodal. Management of patients with mCCMs and epilepsy is challenging.Objective:To evaluate (1) algorhythmic therapeutic sequences in patients with epilepsy associated to mCCMs, (2) whether there are predictive parameters to anticipate the development of drug-resistant epilepsy, and (3) seizure after epilepsy surgery compared to conservatively-treated drug-resistant patients.Methods:All inpatients and outpatients with epilepsy associated to mCCMs from 1990-2010 and follow-up > 12 months available were retrospectively analyzed.Results:Twenty-three patients matched inclusion criteria. Epilepsy became drug-resistant in 18/23 (78%) patients. No predictors were found for development of drug-resistant epilepsy. Median follow-up for both groups was 7.8 years. Nine patients did not qualify for surgical therapy and were treated conservatively. One patient of this cohort (11%) was seizure-free (ILAE class 1). Surgical treatment was performed in nine patients; 7/9 (78%) of these patients were seizure-free (ILAE class 1) after epilepsy surgery for at least 12 months compared with 1/9 patients in the non-operated group. In 7/9 cases (78%) the largest CCM was resected. In 8/9 (89%) not all CCMs were resected.Conclusion:After initial diagnosis of epilepsy associated to mCCMs, a primary conservative approach is reasonable. Surgical treatment can be successful in a large fraction of cases with drug-resistant epilepsy where an epileptogenic lesion is identified. Cases where surgery is not undertaken are likely to remain intractable.

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