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J Neurol Neurosurg Psychiatry 1998;65:648-655 ( November )

Control of epilepsy associated with cerebral arteriovenous malformations after radiosurgery

Hiroki Kurita,a Shunsuke Kawamoto,a Ichiro Suzuki,a Tomio Sasaki,a Masao Tago,b Atsuro Terahara,b Takaaki Kirinoa

a Department of Neurosurgery, b Department of Radiology, Faculty of Medicine, University of Tokyo, Tokyo, Japan

Correspondence to: Dr Hiroki Kurita, Department of Neurosurgery, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Telephone 0081 3 3815 5411; fax 0081 3 5800 8655.

Received 16 October 1997 and in revised form 15 April 1998; Accepted 28 April 1998

OBJECTIVE---To investigate the effect of radiosurgery for symptomatic epilepsy associated with cerebral arteriovenous malformations (AVMs).
METHODS--- Thirty five patients with unruptured epileptogenic AVMs were studied with a mean follow up of 43.0 months. The duration of epilepsy before radiosurgery ranged from 2 months to 21 years (mean 2.8 years). Fifteen patients showed partial seizures; eight of these had associated secondary generalisation. The remaining 20 patients showed only generalised seizures without preceding focal seizures.
RESULTS---At the final follow up examination, 28 patients remained seizure free, whereas seizures continued in seven. Variables significantly associated with continuity of seizures after radiosurgery were the number of seizures before therapy (p<0.01) and duration of epilepsy (p<0.05). According to Engel's classification, the 10 patients with intractable seizures before treatment included five with grade I, four with grade III, and one with grade IV. The frequency of seizures began to decrease several months after radiosurgery; much shorter than the time required for morphological change in the AVMs.
CONCLUSIONS---Radiosurgery seems to be beneficial for seizure control in patients with unruptured epileptogenic AVM.

Keywords: arteriovenous malformation; symptomatic epilepsy; gamma knife; radiosurgery

© 1998 by Journal of Neurology, Neurosurgery, and Psychiatry


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