Intracranial Vascular Malformations and Epilepsy
Intracranial Vascular Malformations and Epilepsy
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DOI：
10.1055/s-0035-1552621
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发表时间：
2015-06-01
影响因子：
2.7
通讯作者：
Salman, Rustam Al-Shahi
中科院分区：
文献类型：
--
作者：
Josephson, Colin B.;Rosenow, Felix;Salman, Rustam Al-Shahi
在颅内血管畸形（IVM）、动静脉畸形（AVM）和海绵状血管畸形（CCM）的范围中，对癫痫特别重要。癫痫发作是这两种疾病的常见表现形式。癫痫发作可能是新发的，也可能继发于脑出血。因此，及时成像对于癫痫发作和AVM或CCM患者至关重要。根据国际抗癫痫联盟的标准，首次发生AVM或CCM相关癫痫发作的患者现在可以被认为患有癫痫。观察性研究和病例系列表明，45%至78%的AVM相关癫痫患者和47%至60%的CCM相关癫痫患者可单独通过抗癫痫药物（AED）实现无癫痫发作。虽然目前的证据表明，癫痫特异性干预前评估未得到充分利用，但有创程序是可用的。随机对照试验和基于人群的研究表明，与保守治疗相比，对未破裂AVM或CCM进行常规干预后的短期功能结局更差。侵入性治疗对IVM相关癫痫的作用产生了不同的结果。病例系列报告了无癫痫发作的高估计值，尽管这些结果尚未在对照观察性研究中重复。对于AVM和CCM相关癫痫，除了常规的AED治疗和不同类型的治疗及其时机外，还需要进行立即侵入性治疗与保守治疗的随机对照试验。
Among the spectrum of intracranial vascular malformations (IVMs), arteriovenous malformations (AVMs), and cavernous malformations (CCMs) are of particular importance for epilepsy. Seizures are a common mode of presentation for both conditions. Seizures may occur de novo or secondary to intracerebral hemorrhage. Timely imaging is thus crucial for patients with seizures and AVMs or CCMs. Patients with a first-ever AVM- or CCM-related seizure can now be considered to have epilepsy according to the International League Against Epilepsy criteria. Observational studies and case series suggest that between 45 to 78% of patients with AVM-related epilepsy and 47 to 60% of patients with CCM-related epilepsy may achieve seizure freedom through antiepileptic drugs (AEDs) alone. Invasive procedures are available although current evidence suggests that epilepsy-specific preintervention evaluations are underused. Randomized controlled trials and population-based studies have demonstrated worse short-term functional outcomes after routine intervention on unruptured AVMs or CCMs when compared with conservative management. The role of invasive therapy for IVM-related epilepsy has yielded mixed results. Case series have reported high estimates of seizure freedom although these results have not been replicated in controlled observational studies. Randomized controlled trials of immediate invasive therapy versus conservative management, in addition to usual care with AEDs and of different types of treatment and their timing, are warranted for AVMs and CCM-related epilepsy.