Secondary epileptogenesis in cerebral arteriovenous malformations
H. S. Yeh and M. D. Privitera
Department of Neurosurgery, University of Cincinnati, College of Medicine, OH 45267-0515.
There is debate as to whether secondary epileptogenesis occurs in humans.
As part of a series of patients with cerebral arteriovenous malformations
and epilepsy, we identified two patients with probable secondary
epileptogenesis in the mesiotemporal regions, ipsilateral but anatomically
distant from an arteriovenous malformation causing seizures. Both patients
had arteriovenous malformations outside the mesiotemporal region and
resection of the arteriovenous malformation and epileptogenic areas
identified by electrocorticography produced initial freedom from seizures.
Three to 6 months later both patients developed a different seizure pattern
that proved to be mesiotemporal in origin by video/electroencephalogram
(one with depth electrodes) and both patients are seizure free after a
second resection of anterotemporal and mesiotemporal regions. Findings
indicating a secondary epileptogenic focus include (1) different seizure
type by patient history, (2) second seizure type by ictal
video/electroencephalographic recordings, and (3) lack of pathologic
abnormalities in the resected mesiotemporal specimens.
