Challenges in the Management of Cavernoma-Related Epilepsy: Seizure Outcomes, Antiseizure Medication Practices, and Access to Intraoperative Technologies in Kazakhstan.
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Abstract
Objective: This study aims to analyze the diagnostic patterns of cavernoma-related epilepsy, the management of antiseizure medications, and clinical outcomes following microsurgical treatment in patients with late-diagnosed epilepsy secondary to cavernous malformations in the Central Asian region.
Methods: A retrospective cross-sectional study was conducted on 60 patients who underwent microsurgical resection for brain cavernous malformations over a 12-year period (2010-2022) at the National Centre for Neurosurgery, Astana, Kazakhstan. All participants were 18 years or older and presented with seizures. Follow-up evaluations were conducted by neurologists, and seizure outcomes were assessed using the 2017 classification criteria of the International League Against Epilepsy.
Results: The mean follow-up period was 83.77 ± 39.81 months. In total, 51.67% of participants demonstrated positive ILAE outcomes, 33.33% had moderate ILAE outcomes, and the remaining 15.00% experienced negative ILAE outcomes. Approximately 47% of patients received antiseizure medication before surgery, primarily as monotherapy with carbamazepine (33%), and administered at a low dose (40%). Early microsurgical resection showed a positive post-surgery seizure outcome. Approximately 67% of patients who experienced seizures within one year prior to surgery showed positive ILAE outcomes, whereas those with a seizure history extending beyond five years were roughly 32% seizure-free (p = 0.01).
Conclusions: Cavernoma-related epilepsy in Central Asia remains a significant clinical challenge, particularly with respect to diagnostic accuracy and antiseizure medication management. In our cohort, only approximately half of patients achieved favorable seizure control following microsurgical resection. Notably, early surgical intervention within one year of seizure onset was associated with improved outcomes, whereas delayed surgery, restricted availability of intraoperative technologies, and suboptimal antiseizure medication practices were linked to less favorable outcomes. Strengthening diagnostic pathways, antiseizure medication management, and expanding access to advanced surgical technologies are critical steps to improving treatment outcomes in a studied patient population.
目的：本研究旨在分析中亚地区海绵状血管瘤继发晚期癫痫患者的诊断模式、抗癫痫药物治疗及显微外科治疗后的临床结果。方法：对哈萨克斯坦阿斯塔纳国家神经外科中心（National Centre for Neurosurgery, Astana, Kazakhstan） 12年间（2010-2022年）60例颅脑海绵状畸形显微手术切除患者进行回顾性横断面研究。所有参与者均为18岁或以上，并出现癫痫发作。由神经科医生进行随访评估，并使用国际抗癫痫联盟2017年分类标准评估癫痫发作结果。结果：平均随访时间为83.77±39.81个月。总的来说，51.67%的参与者表现出ILAE阳性结果，33.33%的参与者表现出中度ILAE结果，其余15.00%的参与者表现出ILAE阴性结果。大约47%的患者在手术前接受了抗癫痫药物治疗，主要是卡马西平单药治疗（33%），并以低剂量给药（40%）。早期显微手术切除显示阳性的术后癫痫结果。手术前一年内癫痫发作的患者中，约67%的患者显示出阳性的ILAE结果，而癫痫发作病史超过5年的患者中，约32%的患者无癫痫发作（p = 0.01）。结论：中亚海绵状瘤相关癫痫仍然是一个重大的临床挑战，特别是在诊断准确性和抗癫痫药物管理方面。在我们的队列中，只有大约一半的患者在显微手术切除后获得了良好的癫痫控制。值得注意的是，癫痫发作一年内的早期手术干预与改善预后相关，而延迟手术、术中技术的限制以及不理想的抗癫痫药物实践与不太有利的预后相关。加强诊断途径、抗癫痫药物管理和扩大先进手术技术的可及性是改善所研究患者群体治疗结果的关键步骤。
期刊介绍：
Brain Sciences (ISSN 2076-3425) is a peer-reviewed scientific journal that publishes original articles, critical reviews, research notes and short communications in the areas of cognitive neuroscience, developmental neuroscience, molecular and cellular neuroscience, neural engineering, neuroimaging, neurolinguistics, neuropathy, systems neuroscience, and theoretical and computational neuroscience. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. Electronic files or software regarding the full details of the calculation and experimental procedure, if unable to be published in a normal way, can be deposited as supplementary material.
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