Treatment of AVM-Associated Epilepsy and the Factors Influencing Outcomes

Abstract

erebrovascular etiologies, including arteriovenous malformations (AVMs), account for up to 15% cases of C epilepsy (7). The risks of hemorrhage associated with these lesions have been well documented; however, the treatment of seizures in patients harboring cerebral AVMs is less well studied (16). Epilepsy is the most common clinical manifestation of unruptured AVMs and second only to hemorrhage in those with ruptures (12). Crawford et al. (4) studied the factors associated with AVMs that increase the likelihood of seizures and found that, overall, the incidence was low, with just 6% carrying a diagnosis of epilepsy before hemorrhage. This is in contrast to prior studies that cited an incidence of 17%e40% in unruptured AVMs (11, 13). Turjman et al. (16) reported their findings on seizure risk related to the angioarchitecture of the AVMs and found that superficial location with feeding by the external carotid artery, or a temporoparietal superficial location and feeding by the middle cerebral artery, were more predictive of epilepsy, an expected result when considering that proximity to cortex results in a more epileptogenic state. Most of these patients present with a first-time seizure; however, up to 43% of patients with newly diagnosed AVMs present with recurrent seizures (9).