Seizure Outcome in Patients with Seizure-Associated Dural Arteriovenous Fistulas

OBJECTIVE: To evaluate seizure outcome in patients with seizure-associated dural arteriovenous fistulas (DAVFs). METHODS: Between 2001 and 2019, 1198 consecutive patients underwent treatment for DAVFs in our neurosci-ence institute. Among these, 48 patients presented with initial seizure before treatment. The seizure outcome after treatment were assessed by patients' medical records, -pdated clinical information, and, when necessary, direct patient contact. RESULTS: Cortical venous reflux was present in all 48 patients with a history of seizure, including 36 cases with single fistula and 12 cases with multiple DAVFs. Complete angiographic occlusion of DAVFs was achieved in all pa-tients at the latest follow-up. There were no immediate or long-term persistent complications after treatment. At 1-year follow-up, 54.2% (26/48) of the patients were seizure-free, and 29.2% (14/48) were medication-free. At 2-year follow-up, 81.3% (39/48) were seizure-free, and 64.6% (31/48) were medication-free. At the last follow-up (mean 7.9 years), 93.8% (45/48) were seizure-free, and 81.3% (39/ 48) were medication-free. Fewer than 5 seizures before treatment and a seizure history of <3 months before treat-ment were 2 independent predictive factors for higher seizure-free rate at 1-year follow-up (before P < 0.05) as well as independent predictive factors for higher medication-free rate at 2-year follow-up (both P < 0.05). CONCLUSIONS: DAVF-related seizures can be effec-tively controlled through treatment of DAVF. Short seizure history and fewer seizures before treatment predict satisfactory seizure outcome after DAVF treatment, which indicates early treatment for seizure-associated DAVFs.

Automated summary

Seizures associated with DAVFs can be effectively controlled through treatment. A shorter seizure history and fewer seizures before treatment predict a satisfactory seizure outcome after DAVF treatment, indicating the importance of early treatment for seizure-associated DAVFs.