Benefits of Exclusion Treatments of Unruptured Brain Arteriovenous Malformations on Epilepsy in Adults

In about 30% of the patients, brain arteriovenous malformations are revealed by seizures. Epileptic patients’ quality of life may be altered. Our objective was to evaluate the benefits of exclusion treatments (radiosurgery, embolization, and/or surgery) on post-therapeutic epilepsy in brain arteriovenous malformations-patients without prior-to-treatment intracranial hemorrhage. Our retrospective observational single-centre study included all consecutive adult patients with an unruptured brain arteriovenous malformation and epilepsy, treated at our Institution from 1995 to 2019 and who were followed for at least one year. Data on brain arteriovenous malformations’ angio-architectural characteristics, on epilepsy, and posttreatment modified Rankin score were collected. The primary endpoint was a seizure-free status (defined as Engel class IA) after exclusion treatment versus conservative management. A hundred and one consecutive adult patients with brain arteriovenous malformations, epilepsy an0 without brain arteriovenous malformation-rupture before any treatment were included, 21 (21%) in the conservative management group vs. 80 (79%) in the exclusion treatment group. After exclusion treatment, 55% patients of the group were Engel IA after treatment versus 10% of the conservative management group (OR 11·37, p < 0·001). Our results suggest that exclusion treatment in unruptured brain arteriovenous malformations with epilepsy is associated with a higher seizure-free rate in comparison with conservative management. Data from randomized controlled studies are necessary to confirm these findings. Funding Statement: The authors report no funding related to this study Declaration of Interests: The authors report no competing interest. Ethics Approval Statement: The study was approved by the local ethics committee and validated by the French National Commission of Informatics and Liberty (Commission Nationale Informatique et Libertes, CNIL).