Intracranial Vascular Malformations and Epilepsy

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Intracranial vascular malformations (IVMs), specifically arteriovenous malformations (AVMs) and cavernous malformations (CCMs), are frequently associated with epilepsy.
• Seizures are a common presentation for AVMs and CCMs, occurring either initially or after hemorrhage.
• The International League Against Epilepsy criteria now include first-ever AVM- or CCM-related seizures under the epilepsy diagnosis.

Purpose of the Study:

• To review the current understanding of epilepsy associated with AVMs and CCMs.
• To evaluate the efficacy of antiepileptic drugs (AEDs) and invasive therapies for IVM-related epilepsy.
• To identify gaps in evidence and suggest future research directions.

Main Methods:

• Review of observational studies and case series on AVM- and CCM-related epilepsy.
• Analysis of outcomes for antiepileptic drug (AED) monotherapy.
• Evaluation of evidence regarding invasive procedures versus conservative management.

Main Results:

• Antiepileptic drugs (AEDs) alone may lead to seizure freedom in 45-78% of AVM-related epilepsy patients and 47-60% of CCM-related epilepsy patients.
• Evidence suggests underutilization of epilepsy-specific pre-intervention evaluations for invasive procedures.
• Routine intervention on unruptured AVMs/CCMs shows worse short-term outcomes compared to conservative management.

Conclusions:

• Antiepileptic drugs (AEDs) are a primary treatment for AVM- and CCM-related epilepsy, achieving seizure freedom in a significant proportion of patients.
• The role of invasive therapy for IVM-related epilepsy is not definitively established, with mixed results and concerns about outcomes.
• Further randomized controlled trials are needed to compare immediate invasive therapy versus conservative management, alongside AEDs, for optimal treatment strategies.