J Neurosurg. 2018 Dec 14;131(6):1763-1772. doi: 10.3171/2018.7.JNS18304. Print 2019 Dec 1.
Seizures are the second-most common presenting symptom in patients with lobar arteriovenous malformations (AVMs). However, few studies have assessed the long-term effect of stereotactic radiosurgery (SRS) on seizure control. The authors of this study assess the outcome of SRS for these patients to identify prognostic factors associated with seizure control.
Patients with AVM who presented with a history of seizure and underwent SRS at the authors' institution between 1987 and 2012 were retrospectively assessed. The total cohort included 155 patients with a mean follow-up of 86 months (range 6-295 months). Primary outcomes assessed were seizure frequency, antiepileptic drug regimen, and seizure freedom for 6 months prior to last follow-up.
Seizure-free status was achieved in 108 patients (70%), with an additional 23 patients (15%) reporting improved seizure frequency as compared to their pre-SRS status. The median time to seizure-free status was estimated to be 12 months (95% CI 0-27 months) as evaluated via Kaplan-Meier survival analysis. The mean seizure frequency prior to SRS was 14.2 (95% CI 5.4-23.1) episodes per year. Although not all patients tried, the proportion of patients successfully weaned off all antiepileptic drugs was 18% (28/155 patients). On multivariate logistic regression, focal impaired awareness seizure type (also known as complex partial seizures) and superficial venous drainage were significantly associated with a decreased odds ratio for seizure-free status at last follow-up (OR 0.37 [95% CI 0.15-0.92] for focal impaired awareness seizures; OR 0.36 [95% CI 0.16-0.81] for superficial venous drainage). The effects of superficial venous drainage on seizure outcome were nonsignificant when excluding patients with < 2 years of follow-up. AVM obliteration did not correlate with long-term seizure freedom (p = 0.202, chi-square test).
This study suggests that SRS improves long-term seizure control and increases the likelihood of being medication free, independently of AVM obliteration. Patients with focal impaired awareness seizures were less likely to obtain long-term seizure relief.
癫痫发作是脑叶动静脉畸形（AVM）患者的第二大常见首发症状。然而，很少有研究评估立体定向放射外科（SRS）对癫痫控制的长期效果。本研究的作者评估了这些患者 SRS 的结果，以确定与癫痫控制相关的预后因素。
回顾性评估了 1987 年至 2012 年在作者机构因癫痫发作就诊并接受 SRS 的 AVM 患者。总队列包括 155 名患者，平均随访 86 个月（范围 6-295 个月）。主要评估结果为最后一次随访前 6 个月的癫痫发作频率、抗癫痫药物治疗方案和癫痫发作频率。
108 名患者（70%）达到无癫痫发作状态，另外 23 名患者（15%）与 SRS 前相比癫痫发作频率有所改善。通过 Kaplan-Meier 生存分析估计无癫痫发作状态的中位时间为 12 个月（95%CI 0-27 个月）。SRS 前的平均癫痫发作频率为每年 14.2 次（95%CI 5.4-23.1）。虽然并非所有患者都尝试过，但成功停用所有抗癫痫药物的患者比例为 18%（155 名患者中的 28 名）。多变量逻辑回归分析显示，局灶性意识障碍性发作类型（也称为复杂部分性发作）和浅表静脉引流与最后随访时无癫痫发作状态的优势比降低显著相关（局灶性意识障碍性发作的优势比为 0.37[95%CI 0.15-0.92]；浅表静脉引流的优势比为 0.36[95%CI 0.16-0.81]）。当排除随访时间<2 年的患者时，浅表静脉引流对癫痫发作结果的影响无统计学意义。AVM 闭塞与长期癫痫无发作无相关性（p=0.202，卡方检验）。
本研究表明，SRS 可改善长期癫痫发作控制，增加无药物治疗的可能性，与 AVM 闭塞无关。局灶性意识障碍性癫痫发作患者获得长期癫痫缓解的可能性较小。
