Introduction The study aimed to analyze clinical dynamic of secondary epilepsy in patients with cerebral arteriovenous malformations (AVM’s) following microsurgical resection (MS), endovascular embolization (EVE), stereotactic radiosurgery (SRS) and combined multimodality treatment.
Materials and methods Among patients with brain AVM treated in our department since January 2011, 202 patients (122 males and 78 females) aged from 5y to 69y (median – 36.5y) with secondary epilepsy were selected. Spetzler-Martin grades were as follows: I – 10 patients (4.9%), II – 39 patients (19.3%), III – 79 patients (39.1%), IV – 50 patients (24.8%), V – 24 patients (11.9%). All patients received anti-seizure medication. We assessed morbidity and mortality and clinical symptoms (by Engel and ILAE score). Mean follow-up period consisted 3 years. Every patient in series underwent EVE as the first stage of treatment, then was either transferred for MS or SRS, or continued endovascular treatment.
Results 104 patients (51.5%) finished treatment. The groups of treatment were as follows: EVE +MS – 30 patients (28,8%), with 4 (13,3%) of them being transferred to MS urgently due to AVM rupture during embolization; EVE +SRS – 20 patients (19,3%); EVE only – 54 patients (51,9%). The percentage of patients with the best ILAE and Engel scores is listed in the table 1 below.
One patient from EVE and 1 patient from EVE +SRS group had no changes in clinical dynamics after complete AVM occlusion. 1 patient had mild improvement (Engel-IVA). Overall morbidity consisted 0.9% (1 pt), severe morbidity was 2.8% (2 pts) and moderate permanent disability was 5.7% (6 pts). Two patients (2.1%) experienced de novo seizures.
Conclusion Endovascular embolization proves to be an effective method that doesn’t exacerbate clinical dynamics of secondary epilepsy, thus should not be taken out of considerations for patients with epileptic presentation of cerebral AVM.
Disclosures A. Brusyanskaya: None. N. Strelnikov: None. A. Moskalev: None. K. Orlov: None.
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