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Benefits from Exclusion Treatment of Unruptured Brain Arteriovenous Malformations on Epilepsy in Adults

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Abstract

Purpose

In approximately 30% of the patients, brain arteriovenous malformations (bAVMs) are revealed by seizures, which may alter the patients’ quality of life. Our objective was to evaluate the benefits of exclusion treatment (radiosurgery, embolization and/or surgery) on posttherapeutic epilepsy in bAVM patients without intracranial hemorrhage prior to treatment.

Methods

Our retrospective observational single-center study included all consecutive adult patients with an unruptured bAVM and epilepsy, treated at our institution from 1995 to 2019 and who were followed for at least 1 year. Data on angioarchitectural characteristics of bAVMs, on epilepsy and posttreatment modified Rankin Scale (mRS) were collected. The primary endpoint was a seizure-free status (defined as Engel class IA) after exclusion treatment versus conservative management.

Results

In this study one hundred and one consecutive adult patients with bAVMs, epilepsy and without bAVM rupture before any treatment were included; 21 (21%) in the conservative management group vs. 80 (79%) in the exclusion treatment group. After exclusion treatment, 55% of the patients from the group were Engel IA after treatment vs. 10% of the conservative management group (odds ratio [OR] 11.37, 95% confidence interval [CI] 2.48–107.24, p < 0.001).

Conclusion

Our results suggest that exclusion treatment in unruptured bAVMs with epilepsy is associated with a higher seizure-free rate in comparison with conservative management. Data from randomized controlled studies are necessary to confirm these findings.

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Abbreviations

AED:

Antiepileptic drug

bAVM:

Brain arteriovenous malformations

DSA:

Digital subtraction angiography

EVE:

Endovascular embolization

mRS:

modified Rankin Scale

SRS:

Stereotaxic radiosurgery

TCGS:

Tonic-clonic generalized seizures

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Authors and Affiliations

  1. Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47–83 Boulevard de l’Hôpital, 75013, Paris, France

    Romain Capocci, Eimad Shotar, Kévin Premat, Maichael Talaat, Atika Talbi, Stéphanie Lenck, Nader Antoine Sourour & Frédéric Clarençon

  2. Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France

    Michaela Bustuchina Vlaicu, Bertrand Mathon, Anne-Laure Boch & Alexandre Carpentier

  3. Sorbonne University Medical School, Paris, France

    Bertrand Mathon, Kévin Premat, Alexandre Carpentier, Vincent Degos & Frédéric Clarençon

  4. Department of Neurosurgery, Louis Pasteur Hospital, Colmar, France

    Mariette Delaitre

  5. Department of Neuro-Intensive Care, Pitie-Salpêtrière Hospital, Paris, France

    Vincent Degos

  6. Department of Radiology, Zagazig University Hospital, Zagazig, Egypt

    Maichael Talaat

  7. GRC BioFast. Paris VI University, Paris, France

    Vincent Degos & Frédéric Clarençon

  8. INSERM U0955, Paris, France

    Michaela Bustuchina Vlaicu

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  1. Romain Capocci
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Correspondence to Frédéric Clarençon.

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Conflict of interest

R. Capocci, M. Bustuchina Vlaicu, E. Shotar, B. Mathon, M. Delaitre, K. Premat, M. Talaat, A. Talbi, A.-L. Boch, S. Lenck, A. Carpentier and V. Degos report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry. N.A. Sourour is consultant for Medtronic, Balt Extrusion, Microvention. F. Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core laboratory; non-related to the study).

Ethical standards

The data were anonymized and retrospectively collected. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements. The study was approved by the local ethics committee and validated by the National Commission of Informatics and Liberty.

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Availability of Data and Material

Data collected for the study are available and include individual participant data that underlie the results reported in this article, after de-identification (tables). The availability will begin 9 months and end 36 months following article publication (proposals may be submitted up to 36 months following article publication). The data access will be given to investigators whose proposed use of the data has been approved by an independent review committee (“learned intermediary”) identified for this purpose, exclusively for individual participant data meta-analysis, upon request directed to the corresponding author; to gain access, data requestors will need to sign a data access agreement.

The authors Michaela Bustuchina Vlaicu and Eimad Shotar contributed equally to the manuscript.

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Capocci, R., Bustuchina Vlaicu, M., Shotar, E. et al. Benefits from Exclusion Treatment of Unruptured Brain Arteriovenous Malformations on Epilepsy in Adults. Clin Neuroradiol 32, 749–760 (2022). https://doi.org/10.1007/s00062-021-01119-w

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