Seizure Outcomes After Interventional Treatment in Cerebral Arteriovenous Malformation–Associated Epilepsy: A Systematic Review and Meta-Analysis

Seizures are the second most common presenting symptom of cerebral arteriovenous malformations (AVMs). Evidence supporting different treatment modalities is continuously evolving and it remains unclear which modality offers better seizure outcomes. To compare various interventional treatment modalit...

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Bibliographic Details
Published in:World neurosurgery 2022-04, Vol.160, p.e9-e22
Main Authors: Lak, Asad M., Cerecedo-Lopez, Christian D., Cha, Julia, Aziz-Sultan, Mohammad Ali, Frerichs, Kai U., Gormley, William B., Mekary, Rania A., Du, Rose, Patel, Nirav J.
Format: Article
Language:English
Subjects:
Anticonvulsants - therapeutic use
Arteriovenous malformation
Endovascular
Epilepsy
Epilepsy - diagnosis
Epilepsy - etiology
Epilepsy - therapy
Humans
Intracranial Arteriovenous Malformations - complications
Intracranial Arteriovenous Malformations - surgery
Meta-analysis
Microsurgery
Radiosurgery
Seizure
Seizures - diagnosis
Treatment Outcome
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Summary:Seizures are the second most common presenting symptom of cerebral arteriovenous malformations (AVMs). Evidence supporting different treatment modalities is continuously evolving and it remains unclear which modality offers better seizure outcomes. To compare various interventional treatment modalities (i.e., microsurgery, radiosurgery, endovascular embolization, or multimodality treatment), regarding outcomes in AVM-associated epilepsy. PubMed, Embase, and Web of Science were searched on December 31, 2020 for studies that evaluated outcomes in patients with AVM-associated epilepsy after undergoing different treatment modalities. Pooled analysis was performed using a random-effects model and stratified by different modalities. Forty-nine studies including 2668 patients were included. Interventional management was associated with a 56.0% probability of seizure freedom and a 73.0% probability of seizure improvement. The probability of discontinuing antiepileptic drugs was estimated at 38.0%. The stratified analysis showed that microsurgery was associated with a higher probability of seizure freedom and seizure improvement than was radiosurgery, endovascular, or multimodality treatment. The probability of antiepileptic drug cessation was also higher after microsurgery compared with radiation therapy; however, only clinical but not statistical significance could be inferred because of the lack of comparative analyses. Interventional management of AVM-related epilepsy was associated with seizure freedom and seizure improvement in 56% and 73% of cases. Microsurgery seemed to be associated with a higher incidence of seizure freedom and seizure improvement than did other modalities. Future well-designed comparative studies are needed to draw definitive conclusions regarding each modality.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2021.09.063