Seizure Outcome in Patients with Seizure-Associated Dural Arteriovenous Fistulas

To evaluate seizure outcome in patients with seizure-associated dural arteriovenous fistulas (DAVFs).

Between 2001 and 2019, 1198 consecutive patients underwent treatment for DAVFs in our neuroscience institute. Among these, 48 patients presented with initial seizure before treatment. The seizure outcome after treatment were assessed by patients' medical records, updated clinical information, and, when necessary, direct patient contact.

Cortical venous reflux was present in all 48 patients with a history of seizure, including 36 cases with single fistula and 12 cases with multiple DAVFs. Complete angiographic occlusion of DAVFs was achieved in all patients at the latest follow-up. There were no immediate or long-term persistent complications after treatment. At 1-year follow-up, 54.2% (26/48) of the patients were seizure-free, and 29.2% (14/48) were medication-free. At 2-year follow-up, 81.3% (39/48) were seizure-free, and 64.6% (31/48) were medication-free. At the last follow-up (mean 7.9 years), 93.8% (45/48) were seizure-free, and 81.3% (39/48) were medication-free. Fewer than 5 seizures before treatment and a seizure history of <3 months before treatment were 2 independent predictive factors for higher seizure-free rate at 1-year follow-up (before P < 0.05) as well as independent predictive factors for higher medication-free rate at 2-year follow-up (both P < 0.05).

DAVF-related seizures can be effectively controlled through treatment of DAVF. Short seizure history and fewer seizures before treatment predict satisfactory seizure outcome after DAVF treatment, which indicates early treatment for seizure-associated DAVFs.