Epilepsy Due to Intracranial Vascular Malformations: How to Set a standard Diagnostic & Therapeutic work up

Background:Intracranial vascular malformations (IVM) present with seizure or epilepsy in a significant amount of affected patients. Also the International League Against Epilepsy considered the patients with a first-ever AVM- or CCM-related seizure as epilepsy.Despite of it, few studies have addressed this issue.The aim of present study was to evaluating the position of this disorder in epilepsy patients and finding the best diagnostic & medical approaches in this regard. Review and results: While the risk of intracerebral bleeding remains a primary concern,a substantial proportion of these people will have seizures or develop epilepsy.Among the spectrum of IVMs, arteriovenous malformations (AVM), and cavernous malformations (CM) have the major role for epilepsy.Seizures in these patients occur due to intracerebral hemorrhage or due to primary lesion itself. AVM and CM differ in both presentation and risk for epilepsy and programmed serial neuroimaging is crucial for these patients. Approximately 25% of people with each condition presented with epilepsy and seizure freedom could be obtained between 45 to 78% of patients with AVM-related epilepsy and 47 to 60% of patients with CM-related epilepsy through antiepileptic drugs (AED) alone in the results of observational studies and case series.In the other hands Invasive procedures are available for these patients. Considering the current evidence, epilepsy-specific pre-intervention may have accompanied with worse short-term functional outcomes after routine intervention on unruptured AVMs or CMs when compared with conservative management. But some recent studies have reported high rate of seizure freedom with invasive therapy (surgical and endovascular intervention) for IVM-related epilepsy although these results need more investigation for better replication. Conclusion:IVMs prevalently present with epilepsy and careful consideration and case selection could help better management in these patients.

Keywords:

Intracranial vascular malformations , seizure , epilepsy , medical management , surgical intervention , endovascular intervention