title: Seizure Outcomes in Patients With Surgically Treated Cerebral Arteriovenous Malformations.
abstract: BACKGROUND
  Epilepsy is the second most common symptom in cerebral arteriovenous malformation (AVM) patients. The consecutive reduction of life quality is a clinically underrated problem because treatment usually focuses on the prevention of intracerebral hemorrhage.
  
  
  OBJECTIVE
  To evaluate postoperative seizure outcome with the aim of more accurate counseling for postoperative seizure outcome.
  
  
  METHODS
  From 1985 to 2012, 293 patients with an AVM were surgically treated by J.S. One hundred twenty-six patients with preoperative seizures or epilepsy could be identified; 103 of 126 had a follow-up of at least 12 months and were included in the analysis. The different epilepsy subtypes were categorized (sporadic seizures, chronic epilepsy, drug-resistant epilepsy [DRE]). Preoperative workup and surgical technique were evaluated. Seizure outcome was analyzed by using International League Against Epilepsy classification.
  
  
  RESULTS
  Sporadic seizures were identified in 41% of patients (chronic epilepsy and DRE were identified in 36% and 23%, respectively). Detailed preoperative epileptological workup was done in 13%. Seizure freedom was achieved in 77% (79% at 5 years, 84% at 10 years). Outcome was significantly poorer in DRE cases. More extensive resection was performed in 11 cases with longstanding symptoms (>24 months) and resulted in better seizure outcome as well as the short duration of preoperative seizure history.
  
  
  CONCLUSIONS
  Patients presenting with AVM-associated epilepsy have a favorable seizure outcome after surgical treatment. Long-standing epilepsy and the progress into DRE markedly deteriorate the chances to obtain seizure freedom and should be considered an early factor in establishing the indication for AVM removal.
authors.affiliation: Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: von der Brelie
authors.forename: Matthias
authors.initials: M
authors.lastname: Simon
authors.forename: Jonas
authors.initials: J
authors.lastname: Esche
authors.forename: Johannes
authors.initials: J
authors.lastname: Schramm
authors.forename: Azize
authors.initials: A
authors.lastname: Boström
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends*; D011788:Quality of Life; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome