Seizures associated with cerebral arteriovenous malformations

Area of Science:

• Neurology
• Neurosurgery
• Vascular Surgery

Background:

• Epilepsy affects 20-45% of patients with cerebral arteriovenous malformations (AVMs).
• Distinguishing between occasional seizures, repetitive seizures, and drug-resistant epilepsy (DRE) is crucial for treatment planning.
• Vascular surgeons must consider epilepsy surgery aspects in cases of frequent seizures or DRE associated with AVMs.

Purpose of the Study:

• To describe the epidemiology, pathophysiology, seizure types, and medical treatment of AVM-associated seizures.
• To outline diagnostic workup strategies, including electroencephalogram (EEG) and invasive evaluations for DRE.
• To define indications for extended resection beyond AVM removal and discuss surgical techniques.

Main Methods:

• Review of AVM-associated seizure epidemiology and pathophysiology.
• Description of diagnostic workup including EEG and video-EEG.
• Explanation of surgical indications and resection techniques for AVMs and associated epilepsy.

Main Results:

• Most patients with preoperative epilepsy become seizure-free after AVM removal.
• Extended resection beyond the AVM is rarely necessary.
• De novo epilepsy can develop postoperatively in 5-15% of patients who never had seizures before.

Conclusions:

• Surgical AVM resection is effective in achieving seizure freedom for most patients.
• Careful patient selection and diagnostic workup are essential, especially for DRE.
• Postoperative epilepsy development is a possibility that requires consideration.