Skip to main content
SpringerLink
Log in

Seizures in Arteriovenous Malformations

  • Chapter
  • First Online:
Seizures in Cerebrovascular Disorders

  • 979 Accesses

Abstract

Arteriovenous malformations (AVMs) are congenital lesions resulting from an abnormal communication of arteries and veins in the absence of an intervening capillary bed. The main risk associated with AVMs is cerebral hemorrhage which can be life threatening or disabling. Unruptured AVMs may present with headaches or seizures; the latter have been reported in 24–40 % of patients with AVMs. A few features may predict a higher seizure occurrence in AVMs such as size of AVM greater than 4 cm, posterior cerebral location, presence of a dilated arterial feeder, and impaired venous drainage. Patients with AVMs who do not have a history of epilepsy and experience a first unprovoked seizure at presentation have greater than 50 % chance of developing epilepsy in the future. The diagnosis of AVMs-associated seizures entails using sophisticated imaging techniques as well as electrophysiology to identify the epileptogenic zone. Treatment of seizures may include the medical and/or surgical approaches, with a variety of surgical approaches having shown efficacy in achieving seizure control.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stapf C, Mast H, Sciacca RR, Berenstein A, Nelson PK, Gobin YP, Pile-Spellman J, Mohr JP. The new york islands avm study: design, study progress, and initial results. Stroke. 2003;34:e29–33.

    Article  CAS  PubMed  Google Scholar 

  2. Furlan AJ, Whisnant JP, Elveback LR. The decreasing incidence of primary intracerebral hemorrhage: a population study. Annals Neurol. 1979;5:367–73.

    Article  CAS  Google Scholar 

  3. Josephson CB, Leach JP, Duncan R, Roberts RC, Counsell CE, Al-Shahi Salman R. Seizure risk from cavernous or arteriovenous malformations: prospective population-based study. Neurology. 2011;76:1548–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Brown RD, Jr., Wiebers DO, Forbes G, O’Fallon WM, Piepgras DG, Marsh WR, Maciunas RJ. The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg. 1988;68:352–7.

    Article  PubMed  Google Scholar 

  5. Fults D, Kelly DL, Jr. Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery. 1984;15:658–62.

    Article  CAS  PubMed  Google Scholar 

  6. Graf CJ, Perret GE, Torner JC. Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg. 1983;58:331–7.

    Article  CAS  PubMed  Google Scholar 

  7. Kader A, Young WL, Pile-Spellman J, Mast H, Sciacca RR, Mohr JP, Stein BM. The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. Neurosurgery. 1994;34:801–7; discussion 807–808.

    Article  CAS  PubMed  Google Scholar 

  8. Miyasaka Y, Yada K, Ohwada T, Kitahara T, Kurata A, Irikura K. An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations. J Neurosurg. 1992;76:239–43.

    Article  CAS  PubMed  Google Scholar 

  9. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65:476–83.

    Article  CAS  PubMed  Google Scholar 

  10. Jellinger K. Vascular malformations of the central nervous system: a morphological overview. Neurosurg Rev. 1986;9:177–216.

    Article  CAS  PubMed  Google Scholar 

  11. Halim AX, Johnston SC, Singh V, McCulloch CE, Bennett JP, Achrol AS, Sidney S, Young WL. Longitudinal risk of intracranial hemorrhage in patients with arteriovenous malformation of the brain within a defined population. Stroke. 2004;35:1697–702.

    Article  PubMed  Google Scholar 

  12. Hofmeister C, Stapf C, Hartmann A, Sciacca RR, Mansmann U, terBrugge K, Lasjaunias P, Mohr JP, Mast H, Meisel J. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke. 2000;31:1307–10.

    Article  CAS  PubMed  Google Scholar 

  13. Turjman F, Massoud TF, Sayre JW, Vinuela F, Guglielmi G, Duckwiler G. Epilepsy associated with cerebral arteriovenous malformations: a multivariate analysis of angioarchitectural characteristics. AJNR Am J Neuroradiol. 1995;16:345–50.

    CAS  PubMed  Google Scholar 

  14. Stein BM, Wolpert SM. Arteriovenous malformations of the brain. I: current concepts and treatment. Arch Neurol. 1980;37:1–5.

    Article  CAS  PubMed  Google Scholar 

  15. Stein BM, Wolpert SM. Arteriovenous malformations of the brain. II: current concepts and treatment. Arch Neurol. 1980;37:69–75.

    Article  CAS  PubMed  Google Scholar 

  16. Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flom RA, Zimmerman RS. Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations. J Neurosurg. 1992;76:918–23.

    Article  CAS  PubMed  Google Scholar 

  17. Taylor CL, Selman WR, Ratcheson RA. Steal affecting the central nervous system. Neurosurgery. 2002;50:679–88; discussion 688–679.

    Article  PubMed  Google Scholar 

  18. Kosnik EJ, Hunt WE, Miller CA. Dural arteriovenous malformations. J Neurosurg. 1974;40:322–9.

    Article  CAS  PubMed  Google Scholar 

  19. Mast H, Mohr JP, Osipov A, Pile-Spellman J, Marshall RS, Lazar RM, Stein BM, Young WL. ’Steal’ is an unestablished mechanism for the clinical presentation of cerebral arteriovenous malformations. Stroke. 1995;26:1215–20.

    Article  CAS  PubMed  Google Scholar 

  20. Mast H, Mohr JP, Thompson JL, Osipov A, Trocio SH, Mayer S, Young WL. Transcranial doppler ultrasonography in cerebral arteriovenous malformations. Diagnostic sensitivity and association of flow velocity with spontaneous hemorrhage and focal neurological deficit. Stroke. 1995;26:1024–7.

    Article  CAS  PubMed  Google Scholar 

  21. Garcin B, Houdart E, Porcher R, Manchon E, Saint-Maurice JP, Bresson D, Stapf C. Epileptic seizures at initial presentation in patients with brain arteriovenous malformation. Neurology. 2012;78:626–31.

    Article  CAS  PubMed  Google Scholar 

  22. Sturiale CL, Rigante L, Puca A, Di Lella G, Albanese A, Marchese E, Di Rocco C, Maira G, Colicchio G. Angioarchitectural features of brain arteriovenous malformations associated with seizures: a single center retrospective series. Eur J Neurol. 2013;20:849–55.

    Article  CAS  PubMed  Google Scholar 

  23. Shankar JJ, Menezes RJ, Pohlmann-Eden B, Wallace C, Terbrugge K, Krings T. Angioarchitecture of brain avm determines the presentation with seizures: proposed scoring system. AJNR Am J Neuroradiol. 2013;34(5):1028–34.

    Article  CAS  PubMed  Google Scholar 

  24. Wilkins RH. Natural history of intracranial vascular malformations: a review. Neurosurgery. 1985;16:421–30.

    Article  CAS  PubMed  Google Scholar 

  25. Hoh BL, Carter BS, Ogilvy CS. Risk of hemorrhage from unsecured, unruptured aneurysms during and after hypertensive hypervolemic therapy. Neurosurgery. 2002;50:1207–11; discussion 1211–1202.

    PubMed  Google Scholar 

  26. Hoh BL, Chapman PH, Loeffler JS, Carter BS, Ogilvy CS. Results of multimodality treatment for 141 patients with brain arteriovenous malformations and seizures: factors associated with seizure incidence and seizure outcomes. Neurosurgery. 2002;51:303–9; discussion 309–311.

    PubMed  Google Scholar 

  27. Alvarez H, Garcia Monaco R, Rodesch G, Sachet M, Krings T, Lasjaunias P. Vein of galen aneurysmal malformations. Neuroimag Clin N Am. 2007;17:189–206.

    Article  CAS  Google Scholar 

  28. Fierstra J, Conklin J, Krings T, Slessarev M, Han JS, Fisher JA, Terbrugge K, Wallace MC, Tymianski M, Mikulis DJ. Impaired peri-nidal cerebrovascular reserve in seizure patients with brain arteriovenous malformations. Brain. 2011;134:100–9.

    Article  PubMed  Google Scholar 

  29. Osipov A, Koennecke HC, Hartmann A, Young WL, Pile-Spellman J, Hacein-Bey L, Mohr JP, Mast H. Seizures in cerebral arteriovenous malformations: type, clinical course, and medical management. Interv Neuroradiol. 1997;3:37–41.

    CAS  PubMed  Google Scholar 

  30. Al-Shahi Salman R. The outlook for adults with epileptic seizure(s) associated with cerebral cavernous malformations or arteriovenous malformations. Epilepsia. 2012;53 Suppl 4:34–42.

    Article  PubMed  Google Scholar 

  31. Schorner W, Bradac GB, Treisch J, Bender A, Felix R. Magnetic resonance imaging (mri) in the diagnosis of cerebral arteriovenous angiomas. Neuroradiology. 1986;28:313–8.

    Article  CAS  PubMed  Google Scholar 

  32. Ostertun B, Solymosi L. Magnetic resonance angiography of cerebral developmental venous anomalies: its role in differential diagnosis. Neuroradiology. 1993;35:97–104.

    Article  CAS  PubMed  Google Scholar 

  33. Warren DJ, Hoggard N, Walton L, Radatz MW, Kemeny AA, Forster DM, Wilkinson ID, Griffiths PD. Cerebral arteriovenous malformations: comparison of novel magnetic resonance angiographic techniques and conventional catheter angiography. Neurosurgery. 2001;48:973–82; discussion 982–973.

    Article  CAS  PubMed  Google Scholar 

  34. Engel J, Jr., Wiebe S, French J, Sperling M, Williamson P, Spencer D, Gumnit R, Zahn C, Westbrook E, Enos B. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the quality standards subcommittee of the american academy of neurology, in association with the american epilepsy society and the american association of neurological surgeons. Neurology. 2003;60:538–47.

    Article  PubMed  Google Scholar 

  35. Piepgras DG, Sundt TM, Jr., Ragoowansi AT, Stevens L. Seizure outcome in patients with surgically treated cerebral arteriovenous malformations. J Neurosurg. 1993;78:5–11.

    Article  CAS  PubMed  Google Scholar 

  36. Yeh HS, Kashiwagi S, Tew JM, Jr., Berger TS. Surgical management of epilepsy associated with cerebral arteriovenous malformations. J Neurosurg. 1990;72:216–23.

    Article  CAS  PubMed  Google Scholar 

  37. Yeh HS, Tew JM, Jr., Gartner M. Seizure control after surgery on cerebral arteriovenous malformations. J Neurosurg. 1993;78:12–8.

    Article  CAS  PubMed  Google Scholar 

  38. Heros RC, Korosue K, Diebold PM. Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery. 1990;26:570–7; discussion 577–578.

    Article  CAS  PubMed  Google Scholar 

  39. Murphy MJ. Long-term follow-up of seizures associated with cerebral arteriovenous malformations. Results of therapy. Arch Neurol. 1985;42:477–9.

    Article  CAS  PubMed  Google Scholar 

  40. Lv X, Li Y, Jiiang C, Yang X, Wu Z. Brain arteriovenous malformations and endovascular treatment: effect on seizures. Interv Neuroradiol. 2010;16:39–45.

    PubMed Central  CAS  PubMed  Google Scholar 

  41. Schauble B, Cascino GD, Pollock BE, Gorman DA, Weigand S, Cohen-Gadol AA, McClelland RL. Seizure outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations. Neurology. 2004;63:683–7.

    Article  CAS  PubMed  Google Scholar 

  42. Izawa M, Hayashi M, Chernov M, Nakaya K, Ochiai T, Murata N, Takasu Y, Kubo O, Hori T, Takakura K. Long-term complications after gamma knife surgery for arteriovenous malformations. J Neurosurg. 2005;102 Suppl:34–37.

    Google Scholar 

  43. Josephson CB, Bhattacharya JJ, Counsell CE, Papanastassiou V, Ritchie V, Roberts R, Sellar R, Warlow CP, Al-Shahi Salman R. Seizure risk with avm treatment or conservative management: prospective, population-based study. Neurology. 2012;79:500–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Mohr JP, Moskowitz AJ, Parides M, Stapf C, Young WL. Hull down on the horizon: a randomized trial of unruptured brain arteriovenous malformations (aruba) trial. Stroke. 2012;43:1744–5.

    Article  CAS  PubMed  Google Scholar 

  45. Mohr JP, Moskowitz AJ, Stapf C, Hartmann A, Lord K, Marshall SM, Mast H, Moquete E, Moy CS, Parides M, Pile-Spellman J, Al-Shahi Salman R, Weinberg A, Young WL, Estevez A, Kureshi I, Brisman JL. The aruba trial: current status, future hopes. Stroke. 2010;41:e537–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Crawford PM, West CR, Shaw MD, Chadwick DW. Cerebral arteriovenous malformations and epilepsy: factors in the development of epilepsy. Epilepsia. 1986;27:270–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University of Virginia, McKim Hall, 22908, PO Box 800394, Charlottesville, VA, USA

    Prachi Mehndiratta MD

  2. SSM-Neurosciences Institute and St. Louis University, 12255 DePaul Health Drive, Suite 200, St. Louis, Missouri, 63044, USA

    Amer Alshekhlee MD, MSc (Assoc. Prof)

Authors
  1. Prachi Mehndiratta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amer Alshekhlee MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prachi Mehndiratta MD .

Editor information

Editors and Affiliations

  1. Department of Neurology Director, Epilepsy Center, George Washington University, Washington DC, District of Columbia, USA

    Mohamad Z. Koubeissi

  2. SSM-Neurosciences Institute and St. Louis University, St. Louis University, Missouri, Missouri, USA

    Amer Alshekhlee

  3. Vascular Neurology Fellow, University of Virginia, Charlottesville, Virginia, Virginia, USA

    Prachi Mehndiratta

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Mehndiratta, P., Alshekhlee, A. (2015). Seizures in Arteriovenous Malformations. In: Koubeissi, M., Alshekhlee, A., Mehndiratta, P. (eds) Seizures in Cerebrovascular Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2559-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2559-9_7

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2558-2

  • Online ISBN: 978-1-4939-2559-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation