Radiosurgery for unruptured cerebral AVMs: focused on long-term seizure outcome

Keywords: arteriovenous malformation, gamma knife, seizures, radiosurgery, outcome

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     To date, seizures in relation to arteriovenous malformations (AVM) have been a secondary target of most studies. The insufficient evaluation, in conjunction with the lack of consistent seizure outcome assessment, has made it been difficult to draw conclusions about seizure outcome after radiosurgery for AVM. 
     This study aimed to determine the effect of radiosurgery on seizure outcome depending on AVM obliteration and on the development of new seizure in patients with AVM.
     86/161 AVM patients had a history of seizure before radiosurgery.
     Between 1997 and 2006, 161 consecutive patients underwent radiosurgery for unruptured AVM and were retrospectively assessed with a mean follow up of 89.8 months by their medical records, updated clinical information and, when necessary, direct patient contact. Seizure outcome was assessed using the Engel seizure frequency scoring system.
     Of the 86 patients, 76.7% (66/86) were seizure-free and 58.1% (50/86) were medication-free at the last follow-up visit. Of the patients who achieved AVM obliteration, 96.7% (58/60) were seizure-free while 30.8% (8/26) of those patients who did not achieve AVM obliteration were seizure-free (P=0.001). The proportion of patients who were medication-free was 81.7% (49/60) of the patients with obliteration and 3.8% (1/26) of patients without obliteration (P<0.001). Of the 75 patients with no history of seizure before radiosurgery, 10 had provoked seizures due to the direct and indirect radiosurgical influences after radiosurgery.
     This was a retrospective study.
     Although radiosurgery tends to cause seizures temporarily, radiosurgery may improve seizure outcomes in patients with AVM-related seizures, especially in patients with AVM obliteration.
     Radiosurgery should be considered for patients with AVMs and epilepsy.


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