Q) Does the brain AVM treatment improve the seizure outcomes in patient with brain AVM related epilepsy?

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A) Seizure is the most common presentation of AVM. Since 1947, there is no randomized controlled trial (RCT) and only 2 case-controlled studies directly compare interventional treatment and conservative treatment. A meta-analysis of 2 case-controlled studies (N=106) conducted by Josephson et al found that the seizure outcomes were not different between 2 groups (the pooled, weighted relative risk of 0.99, (95% CI 0.69-1.43). 

There is also no RCT evaluating different treatment modality and seizure outcomes. The meta-analysis on this topic (2013) reported that the highest rate of seizure free outcome for surgical resection (78%), followed by stereotactic radiosurgery (SRS) (63%) and embolization (49%). Interestingly SRS-treated patients who had complete AVM eradication had the greatest likelihood of seizure free (85%).  Embolization was associated with a significantly greater risk of new onset seizure (39%), surgery (6%) and SRS (5%). Complete eradication of the AVM was the best associated with seizure control.

Recent systematic review and meta-analysis of seizure outcomes after SRS for AVM demonstrated 73% of patients was achieved seizure control (seizure freedom/seizure improvement). Predictor of seizure freedom were generalized seizure (OR: 2.3), history of seizure </= 5 times (OR: 6.8), AVM obliteration (OR=4.61) and previous AVM hemorrhage (OR: 4.83).

In summary, Josephson mentioned that “There is currently insufficient evidence available to determine if invasive AVM management is superior to antiepileptic treatment only for seizure freedom measured at last follow-up.”

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