[Evolution of epileptic seizures associated with cerebral arteriovenous malformations after radiosurgery].
The goal of this study is to evaluate the response of epileptic seizures associated with cerebral arteriovenous malformations following radiosurgery and determine the factors associated with a positive outcome. The series included 210 patients (123 men, 87 women) with a mean age of 33. One hundred seventy three patients out of 210 were controlled after radiosurgery. Seizures completely disappeared in 58% of cases and decreased in 18%. Anti-epileptic treatment was stopped in 44%. Sex and age upon seizure appearance were not found as determining factors in patients whose seizures disappeared after radiosurgery. Generalized seizures disappeared following radiosurgery in 90.7%, partial secondary generalized seizures in 53.5%, and partial seizures in only 39.6%. Frontal or temporal malformations are associated with a better response after radiosurgery than sylvian or rolandic location. Seizure disappearance was maximal in case of isolated seizure prior to the radiosurgery (84.4%), was reduced to 61.2% when seizures were limited to 2 to 20, and disappeared in 21.4% in severe seizures. Epilepsy present less than 3 years prior to radiosurgery disappeared in 71.9%; was reduced to 45% when the delay was over 3 years. Seizures disappeared in 64.4% when the malformation was obliterated, they were reduced to 46.9% when malformations persisted. The persistence of severe seizures following radiosurgery was linked to persistence of the malformation. On the other hand early seizures occurred in 3.3% during the first 48 hours following radiosurgery; they disappeared in 72.2% after that period. De novo seizures also occurred in 1.7% and disappeared in all these cases. In conclusion, seizures associated with cerebral arteriovenous malformations respond well to radiosurgery; the malformation obliteration evokes its association with the seizure; the seizure disappearance in spite of persistence of the malformation evokes the positive effect of radiotherapy on epileptic seizures.
Ghossoub
M
M
Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris.
Nataf
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Merienne
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L
Devaux
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Turak
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Page
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Roux
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D004827:Epilepsy / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D004829:Epilepsy, Generalized / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D016896:Treatment Outcome
D000927:Anticonvulsants