title: Epilepsy after bypass surgery in adult moyamoya disease.
abstract: BACKGROUND
  Postoperative seizure, well-known in association with other pathologies, has been rarely discussed in adult moyamoya disease.
  
  
  OBJECTIVE
  We evaluated postoperative seizures in adult patients with moyamoya undergoing revascularization surgery.
  
  
  METHODS
  From 2001 to 2007, 43 adult patients with moyamoya disease underwent 53 revascularization surgeries, consisting of direct bypass with or without indirect bypass. Incidence and profile of postoperative seizures were investigated, with evaluation of influencing factors. Multivariable analysis using a generalized estimation equation was performed to determine which factors were related to postoperative seizure.
  
  
  RESULTS
  Seizures developed in 10 sides (18.9%) after revascularization for moyamoya disease, including immediate (<24 hours, n = 0), early (1-7 days, n = 5), late (8-30 days, n = 0), and delayed seizures (≥1 month, n = 7). Early and subsequent delayed seizures developed in the same lesions in 2 patients. Seizures developed only in the patients with combined direct and indirect revascularization. Postoperative temporary neurological deficits with imaging abnormalities were significantly related to postoperative nondelayed seizures (P = .02). Delayed seizures were significantly different according to the location of the recipient artery (P = .03), especially with the frontal branches. By multivariable analysis, revascularization using frontal branches trended toward increased incidence of delayed postoperative seizure, with adjusted odds ratio of 13.78 (95% confidence interval, 1.7-114.1).
  
  
  CONCLUSIONS
  In adult patients with moyamoya disease, the incidence of delayed postoperative seizure seems to be higher than that of other pathologies. The delayed, pronounced formation of synangiosis in moyamoya disease may be related to the development of such delayed postoperative seizures, especially when the location of the recipient artery is frontal.
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Jin
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Gyojun
authors.initials: G
authors.lastname: Hwang
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Lee
authors.forename: Young-Seob
authors.initials: YS
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002548:Cerebral Revascularization / Q000009:adverse effects*; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D011877:Radionuclide Imaging; D055815:Young Adult