Epileptogenic Developmental Venous Anomaly

Jacobs, Bart C.; Wiest, Roland; Jann, Kay; König, Thomas; Meyer, Klaus; Hauf, Martinus

doi:10.1177/1550059412464463

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…Indications for surgical resection include the prevention of intracranial hemorrhage and/or the treatment of medically intractable seizures. While a few case reports have proposed occasional ictogenesis with other cerebral vascular malformations, such as developmental venous anomalies and capillary telangiectasia [137, 172, 185], these lesions are not typically associated with epilepsy and will not be considered further.…”

Section: Vascular Malformationsmentioning

confidence: 99%

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

2014

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Epilepsy is a debilitating neurological disorder affecting approximately 1 % of the world’s population. Drug-resistant focal epilepsies are potentially surgically remediable. Although epilepsy surgery is dramatically underutilized among medically refractory patients, there is an expanding collection of evidence supporting its efficacy which may soon compel a paradigm shift. Of note is that a recent randomized controlled trial demonstrated that early resection leads to considerably better seizure outcomes than continued medical therapy in patients with pharmacoresistant temporal lobe epilepsy. In the present review, we provide a timely update of seizure freedom rates and predictors in resective epilepsy surgery, organized by the distinct pathological entities most commonly observed. Class I evidence, meta-analyses, and individual observational case series are considered, including the experiences of both our institution and others. Overall, resective epilepsy surgery leads to seizure freedom in approximately two thirds of patients with intractable temporal lobe epilepsy and about one half of individuals with focal neocortical epilepsy, although only the former observation is supported by class I evidence. Two common modifiable predictors of postoperative seizure freedom are early operative intervention and, in the case of a discrete lesion, gross total resection. Evidence-based practice guidelines recommend that epilepsy patients who continue to have seizures after trialing two or more medication regimens should be referred to a comprehensive epilepsy center for multidisciplinary evaluation, including surgical consideration.

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Section: Vascular Malformationsmentioning

confidence: 99%

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

2014

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“…A total of 39 studies were included after full‐text review, with 66 patients included for analysis 8–46 . Figure 1 presents the flow diagram detailing the selection process.…”

Section: Resultsmentioning

confidence: 99%

Epilepsy and cerebral developmental venous anomalies (DVAs): A systematic review

Meskine

Reise

et al. 2023

Epileptic Disorders

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Objective Cerebral developmental venous anomalies (DVAs) are frequent and rarely symptomatic. When symptomatic, DVAs may present with seizures; however, little is known about the characteristics of DVA‐related epilepsy. In this systematic review, we aim to describe the clinical and paraclinical features of patients with DVA‐related epilepsy. Methods This review was registered on PROSPERO (CRD42021218711). We searched the MEDLINE/PubMed and Scopus databases for case reports/series on patients with DVAs complicated by seizures. Studies describing patients with a potentially epileptogenic comorbid lesion close to their seizure focus were excluded. Descriptive statistical analyses were performed to synthetize patient characteristics. The methodological quality of each study was evaluated using a standardized appraisal tool. Results In total, 66 patients were included from 39 articles. The frontal lobe was the most common location for DVAs. The superior sagittal sinus drained half of the DVAs. Seizures were inaugural in most cases, and the most common manifestations accompanying seizures were headaches. EEG was abnormal in 93% of cases, but only 26% had characteristic epileptic spikes. More than half the patients suffered a medical complication due to their DVA, with hemorrhage and thrombosis being the most common. Refractory seizures were encountered in 19% of individuals. At 12 months of follow‐up, 75% of patients were seizure free. Most included studies were at low risk of bias. Significance Epilepsy can be a complication of DVAs; these DVAs are mostly frontal or parietal, draining via the superior sagittal sinus or the vein of Galen.

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“…As mentioned previously, SWI sequences are appropriate by detecting the phase differences of tiny vascular lesions, such as the caput medusae and telangiectasias, due to combination of slow flow and concentration of deoxyhaemoglobin in sequences (28). Recently, DVA lesions have been suggested as the main localized pathology of focal seizures in DRE cases when no epileptogenic foci can be discovered (29). Probable mechanisms are subclinical hemorrhage accompanied by a cavernous malformation and/or restricted outflow or increased inflow, causing intermittent cortical hyperemia and dysfunction as an epileptic foci (26).…”

Section: Discussionmentioning

confidence: 99%

The Role of Susceptibility-Weighted Imaging and Dedicated MRI Protocols in the Diagnostic Evaluation of Patients with Drug-Resistant Epilepsy

et al. 2018

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Background: Near one-third of epileptic cases never achieve remission, despite optimal medication use. In these patients, various surgical procedures can be helpful. However, surgical success is directly associated with the ability to localize precisely the region of seizure onset. Objectives: The goal of this study was to evaluate the role of susceptibility weighted imaging (SWI) in detecting intracerebral lesions and localizing epileptogenic zones in addition to conventional MRI with routine epilepsy protocol in drug-resistant epileptic patients. Methods:The study was carried out at an academic medical center in a major metropolitan city, and all participants underwent conventional MRI assessment with seizure protocol and SWI evaluation. Results: During the study period, 59 cases met the criteria. Thirty-four were male (57.6%) and twenty-five were female. Mean age of participants was 30 years, and mean age at the time of epilepsy onset was 11. In 50 cases (85%), there was evidence of brain abnormalities in conventional MRI and/or SWI. Brain abnormalities were also evident in conventional MRI evaluation of 47 cases (79%). In three out of twelve cases with normal conventional MRI with routine epilepsy protocol, SWI showed brain abnormalities. In 20 cases (40%), the same lateralization or localized lesions were detected in EEG and MRI. More information from SWI was reported in 13 patients (22%). In two cases, in which EEG showed evidence of partial seizures, conventional MRI showed no abnormality while SWI showed abnormal vascular cluster. In one of these two cases, caput medusa, in agreement with developmental venous anomaly, was reported. In one case, conventional MRI was normal while SWI showed evidence of cavernoma. In another patient, in addition to the lesion detectable in conventional MRI, SWI found two other lesions in agreement with cavernomas. Conclusions: Susceptibility weighted imaging can be helpful in localizing epileptogenic zones, which are not detectable by conventional MRI with routine epilepsy protocol, in patients with drug-resistant epilepsy.

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Epileptogenic Developmental Venous Anomaly

Cited by 10 publications

References 16 publications

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

Epilepsy and cerebral developmental venous anomalies (DVAs): A systematic review

The Role of Susceptibility-Weighted Imaging and Dedicated MRI Protocols in the Diagnostic Evaluation of Patients with Drug-Resistant Epilepsy

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