Romain Capocci1, Michaela Bustuchina Vlaicu2,3, Eimad Shotar1, Bertrand Mathon2,4, Mariette Delaitre5, Kévin Premat1,4, Maichael Talaat1,6, Atika Talbi1, Anne-Laure Boch2, Stéphanie Lenck1, Alexandre Carpentier2,4, Vincent Degos4,7,8, Nader Antoine Sourour1, Frédéric Clarençon9,10,11. 1. Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 2. Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France. 3. INSERM U0955, Paris, France. 4. Sorbonne University Medical School, Paris, France. 5. Department of Neurosurgery, Louis Pasteur Hospital, Colmar, France. 6. Department of Radiology, Zagazig University Hospital, Zagazig, Egypt. 7. Department of Neuro-Intensive Care, Pitie-Salpêtrière Hospital, Paris, France. 8. GRC BioFast. Paris VI University, Paris, France. 9. Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. frederic.clarencon@aphp.fr. 10. Sorbonne University Medical School, Paris, France. frederic.clarencon@aphp.fr. 11. GRC BioFast. Paris VI University, Paris, France. frederic.clarencon@aphp.fr.
Abstract
PURPOSE: In approximately 30% of the patients, brain arteriovenous malformations (bAVMs) are revealed by seizures, which may alter the patients' quality of life. Our objective was to evaluate the benefits of exclusion treatment (radiosurgery, embolization and/or surgery) on posttherapeutic epilepsy in bAVM patients without intracranial hemorrhage prior to treatment. METHODS: Our retrospective observational single-center study included all consecutive adult patients with an unruptured bAVM and epilepsy, treated at our institution from 1995 to 2019 and who were followed for at least 1 year. Data on angioarchitectural characteristics of bAVMs, on epilepsy and posttreatment modified Rankin Scale (mRS) were collected. The primary endpoint was a seizure-free status (defined as Engel class IA) after exclusion treatment versus conservative management. RESULTS: In this study one hundred and one consecutive adult patients with bAVMs, epilepsy and without bAVM rupture before any treatment were included; 21 (21%) in the conservative management group vs. 80 (79%) in the exclusion treatment group. After exclusion treatment, 55% of the patients from the group were Engel IA after treatment vs. 10% of the conservative management group (odds ratio [OR] 11.37, 95% confidence interval [CI] 2.48-107.24, p < 0.001). CONCLUSION: Our results suggest that exclusion treatment in unruptured bAVMs with epilepsy is associated with a higher seizure-free rate in comparison with conservative management. Data from randomized controlled studies are necessary to confirm these findings.
PURPOSE: In approximately 30% of the patients, brain arteriovenous malformations (bAVMs) are revealed by seizures, which may alter the patients' quality of life. Our objective was to evaluate the benefits of exclusion treatment (radiosurgery, embolization and/or surgery) on posttherapeutic epilepsy in bAVM patients without intracranial hemorrhage prior to treatment. METHODS: Our retrospective observational single-center study included all consecutive adult patients with an unruptured bAVM and epilepsy, treated at our institution from 1995 to 2019 and who were followed for at least 1 year. Data on angioarchitectural characteristics of bAVMs, on epilepsy and posttreatment modified Rankin Scale (mRS) were collected. The primary endpoint was a seizure-free status (defined as Engel class IA) after exclusion treatment versus conservative management. RESULTS: In this study one hundred and one consecutive adult patients with bAVMs, epilepsy and without bAVM rupture before any treatment were included; 21 (21%) in the conservative management group vs. 80 (79%) in the exclusion treatment group. After exclusion treatment, 55% of the patients from the group were Engel IA after treatment vs. 10% of the conservative management group (odds ratio [OR] 11.37, 95% confidence interval [CI] 2.48-107.24, p < 0.001). CONCLUSION: Our results suggest that exclusion treatment in unruptured bAVMs with epilepsy is associated with a higher seizure-free rate in comparison with conservative management. Data from randomized controlled studies are necessary to confirm these findings.
Authors: C Hofmeister; C Stapf; A Hartmann; R R Sciacca; U Mansmann; K terBrugge; P Lasjaunias; J P Mohr; H Mast; J Meisel Journal: Stroke Date: 2000-06 Impact factor: 7.914
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