title: Seizure and anticonvulsant outcomes following stereotactic radiosurgery for intracranial arteriovenous malformations.
abstract: OBJECTIVE
  Epilepsy associated with arteriovenous malformations (AVMs) has an unclear course after stereotactic radiosurgery (SRS). Neither the risks of persistent seizures nor the requirement for postoperative antiepileptic drugs (AEDs) are well defined.
  
  
  METHODS
  The authors performed a retrospective review of all patients with AVMs who underwent SRS at the University of Virginia Health System from 1989 to 2012. Seizure status was categorized according to a modified Engel classification. The effects of demographic, AVM-related, and SRS treatment factors on seizure outcomes were evaluated with logistic regression analysis. Changes in AED status were evaluated using McNemar's test.
  
  
  RESULTS
  Of the AVM patients with pre- or post-SRS seizures, 73 with pre-SRS epilepsy had evaluable data for subsequent analysis. The median patient age was 37 years (range 5-69 years), and the median follow-up period was 65.6 months (range 12-221 months). Sixty-five patients (89%) achieved seizure remission (Engel Class IA or IB outcome). Patients presenting with simple partial or secondarily generalized seizures were more likely to achieve Engel Class I outcome (p = 0.045). Twenty-one (33%) of 63 patients tapered off of pre-SRS AEDs. The incidence of freedom from AED therapy increased significantly after SRS (p < 0.001, McNemar's test). Of the Engel Class IA patients who continued AED therapy, 54% had patent AVM nidi, whereas only 19% continued AED therapy with complete AVM obliteration (p = 0.05).
  
  
  CONCLUSIONS
  Stereotactic radiosurgery is an effective treatment for long-term AVM-related epilepsy. Seizure-free patients on continued AED therapy were more likely to have residual AVM nidi. Simple partial or secondarily generalized seizure type were associated with better seizure outcomes following SRS.
authors.affiliation: Departments of 1Neurological Surgery.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Przybylowski
authors.affiliation: Departments of 1Neurological Surgery.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Departments of 1Neurological Surgery.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Departments of 1Neurological Surgery.
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.affiliation: 2Neurology, and.
authors.forename: Mark
authors.initials: M
authors.lastname: Quigg
authors.affiliation: Departments of 1Neurological Surgery.
authors.forename: Blair
authors.initials: B
authors.lastname: Dodson
authors.affiliation: Departments of 1Neurological Surgery.
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Ball
authors.affiliation: Departments of 1Neurological Surgery.|3Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: AED = antiepileptic drug; AVM = arteriovenous malformation; CI = confidence interval; DSA = digital subtraction angiography; GKRS = Gamma Knife radiosurgery; Gamma Knife radiosurgery; OR = odds ratio; RIC = radiation-induced change; SRS = stereotactic radiosurgery; antiepileptic drug; arteriovenous malformation; epilepsy; obliteration; seizure; stereotactic radiosurgery