Przybylowski Colin J, Ding Dale, Starke Robert M, Yen Chun-Po, Quigg Mark, Dodson Blair, Ball Benjamin Z, Sheehan Jason P
Departments of 1Neurological Surgery.
2Neurology, and.
J Neurosurg. 2015 Jun;122(6):1299-305. doi: 10.3171/2014.11.JNS141388. Epub 2015 Jan 23.
Epilepsy associated with arteriovenous malformations (AVMs) has an unclear course after stereotactic radiosurgery (SRS). Neither the risks of persistent seizures nor the requirement for postoperative antiepileptic drugs (AEDs) are well defined.
The authors performed a retrospective review of all patients with AVMs who underwent SRS at the University of Virginia Health System from 1989 to 2012. Seizure status was categorized according to a modified Engel classification. The effects of demographic, AVM-related, and SRS treatment factors on seizure outcomes were evaluated with logistic regression analysis. Changes in AED status were evaluated using McNemar's test.
Of the AVM patients with pre- or post-SRS seizures, 73 with pre-SRS epilepsy had evaluable data for subsequent analysis. The median patient age was 37 years (range 5-69 years), and the median follow-up period was 65.6 months (range 12-221 months). Sixty-five patients (89%) achieved seizure remission (Engel Class IA or IB outcome). Patients presenting with simple partial or secondarily generalized seizures were more likely to achieve Engel Class I outcome (p = 0.045). Twenty-one (33%) of 63 patients tapered off of pre-SRS AEDs. The incidence of freedom from AED therapy increased significantly after SRS (p < 0.001, McNemar's test). Of the Engel Class IA patients who continued AED therapy, 54% had patent AVM nidi, whereas only 19% continued AED therapy with complete AVM obliteration (p = 0.05).
Stereotactic radiosurgery is an effective treatment for long-term AVM-related epilepsy. Seizure-free patients on continued AED therapy were more likely to have residual AVM nidi. Simple partial or secondarily generalized seizure type were associated with better seizure outcomes following SRS.
立体定向放射外科治疗（SRS）后，动静脉畸形（AVM）相关癫痫的病程尚不明确。持续性癫痫发作的风险以及术后抗癫痫药物（AED）的使用需求均未得到明确界定。
作者对1989年至2012年在弗吉尼亚大学健康系统接受SRS治疗的所有AVM患者进行了回顾性研究。癫痫发作状态根据改良的恩格尔分类法进行分类。采用逻辑回归分析评估人口统计学、AVM相关因素和SRS治疗因素对癫痫发作结果的影响。使用麦克尼马尔检验评估AED状态的变化。
在有SRS前或SRS后癫痫发作的AVM患者中，73例SRS前患有癫痫的患者有可评估数据用于后续分析。患者的中位年龄为37岁（范围5 - 69岁），中位随访期为65.6个月（范围12 - 221个月）。65例患者（89%）实现了癫痫发作缓解（恩格尔I A或I B级结果）。表现为单纯部分性或继发性全身性癫痫发作的患者更有可能达到恩格尔I级结果（p = 0.045）。63例患者中有21例（33%）逐渐停用了SRS前使用的AED。SRS后停用AED治疗的发生率显著增加（p < 0.001，麦克尼马尔检验）。在继续接受AED治疗的恩格尔I A级患者中，54%的患者AVM巢未闭，而只有19%的患者在AVM完全闭塞后继续接受AED治疗（p = 0.05）。
立体定向放射外科治疗是治疗长期AVM相关癫痫的有效方法。持续接受AED治疗的无癫痫发作患者更有可能有残留的AVM巢。单纯部分性或继发性全身性癫痫发作类型与SRS后更好的癫痫发作结果相关。
