title: Medical vs. invasive therapy in AVM-related epilepsy: Systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare invasive arteriovenous malformation (AVM) therapy to conservative management using only antiepileptic drugs (AEDs) for achieving seizure freedom in patients with AVM-related epilepsy.
  
  
  METHODS
  We searched Medline, Embase, and Cochrane Central up to June 2015 using epilepsy and AVM Medical Subject Headings and keywords. We included original research involving controlled observational cohort studies or randomized controlled trials (RCTs) comparing seizure outcomes between invasive AVM treatments vs. AED management alone, and uncontrolled case series of invasive AVM therapy for seizures that contained ≥20 patients. The estimates of seizure freedom were pooled using meta-analysis for the controlled trials, while the estimates for the case series were evaluated using descriptive statistics.
  
  
  RESULTS
  Of 2,166 identified abstracts, 98 were reviewed in full text, of which 31 were included in the final dataset. We identified 2 controlled observational studies (n = 106 patients) and 29 uncontrolled case series. We identified 1 RCT but it did not report seizure outcomes. The pooled risk ratio for seizure freedom in controlled studies (0.99; 95% confidence interval [CI] 0.69, 1.43) did not indicate superiority to either approach. Seizure freedom in case series varied from 19% (95% CI 11, 30%) to 95% (95% CI 76, 99%) at last follow-up.
  
  
  CONCLUSIONS
  There is insufficient evidence available to determine if invasive AVM management is superior to AED only for controlling seizures. An RCT of interventional vs. medical management using standardized epilepsy-specific presurgical protocols is warranted.
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada.
authors.forename: Colin B
authors.initials: CB
authors.lastname: Josephson
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada.
authors.forename: Khara
authors.initials: K
authors.lastname: Sauro
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada. nathalie.jette@albertahealthservices.ca.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000639:trends; D064887:Observational Studies as Topic; D016634:Radiosurgery / Q000009:adverse effects / Q000639:trends
chemical_list: D000927:Anticonvulsants