Seizure risk from cavernous or arteriovenous malformations

prospective population-based study

C. B. Josephson, J.-P. Leach, R. Duncan, R. C. Roberts, C. E. Counsell, R. Al-Shahi Salman, Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Objectives: To determine the risk of epileptic seizures due to a brain arteriovenous malformation (AVM) or cavernous malformation (CM).

Methods: In a prospective population-based study of new diagnoses of AVMs (n = 229) or CMs (n = 139) in adults in Scotland in 1999–2003, we used annual medical records surveillance, general practitioner follow-up, and patient questionnaires to quantify the risk of seizures between clinical presentation and AVM/CM treatment, last follow-up, or death.

Results: The 5-year risk of first-ever seizure after presentation was higher for AVMs presenting with intracranial hemorrhage or focal neurologic deficit (ICH/FND: n = 119; 23%, 95% confidence interval [CI] 9%–37%) than for incidental AVMs (n = 40; 8%, 95% CI 0%–20%), CMs presenting with ICH/FND (n = 38; 6%, 95% CI 0%–14%), or incidental CMs (n = 57; 4%, 95% CI 0%–10%). For adults who had never experienced ICH/FND, the 5-year risk of epilepsy after first-ever seizure was higher for CMs (n = 23; 94%, 95% CI 84%–100%) than AVMs (n = 37; 58%, 95% CI 40%–76%; p = 0.02). Among adults who never experienced ICH/FND and presented with or developed epilepsy, there was no difference in the proportions achieving 2-year seizure freedom over 5 years between AVMs (n = 43; 45%, 95% CI 20%–70%) and CMs (n = 35; 47%, 95% CI 27%–67%).

Conclusions: AVM-related ICH confers a significantly higher risk of a first-ever seizure compared to CMs or incidental AVMs. Adults with a CM have a high risk of epilepsy after a first-ever seizure but achieve seizure freedom as frequently as those with epilepsy due to an AVM.
Original languageEnglish
Pages (from-to)1548-1554
Number of pages7
JournalNeurology
Volume76
Issue number18
DOIs
Publication statusPublished - 3 May 2011

Fingerprint

Arteriovenous Malformations
Seizures
Confidence Intervals
Epilepsy
Population
Intracranial Hemorrhages
Scotland
Neurologic Manifestations
General Practitioners
Medical Records
Brain

Keywords

  • adult
  • epilepsy
  • female
  • hemangioma
  • humans
  • intracranial arteriovenous malformations
  • male
  • middle aged
  • odds ratio
  • prevalence
  • prospective studies
  • questionnaires
  • risk
  • Scotland
  • seizures
  • cavernous
  • central nervous system

Cite this

Josephson, C. B., Leach, J-P., Duncan, R., Roberts, R. C., Counsell, C. E., Al-Shahi Salman, R., & Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators (2011). Seizure risk from cavernous or arteriovenous malformations: prospective population-based study. Neurology, 76(18), 1548-1554. https://doi.org/10.1212/WNL.0b013e3182190f37

Seizure risk from cavernous or arteriovenous malformations : prospective population-based study. / Josephson, C. B.; Leach, J.-P.; Duncan, R.; Roberts, R. C.; Counsell, C. E.; Al-Shahi Salman, R.; Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators.

In: Neurology, Vol. 76, No. 18, 03.05.2011, p. 1548-1554.

Research output: Contribution to journalArticle

Josephson, CB, Leach, J-P, Duncan, R, Roberts, RC, Counsell, CE, Al-Shahi Salman, R & Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators 2011, 'Seizure risk from cavernous or arteriovenous malformations: prospective population-based study', Neurology, vol. 76, no. 18, pp. 1548-1554. https://doi.org/10.1212/WNL.0b013e3182190f37
Josephson, C. B. ; Leach, J.-P. ; Duncan, R. ; Roberts, R. C. ; Counsell, C. E. ; Al-Shahi Salman, R. ; Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators. / Seizure risk from cavernous or arteriovenous malformations : prospective population-based study. In: Neurology. 2011 ; Vol. 76, No. 18. pp. 1548-1554.
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abstract = "Objectives: To determine the risk of epileptic seizures due to a brain arteriovenous malformation (AVM) or cavernous malformation (CM).Methods: In a prospective population-based study of new diagnoses of AVMs (n = 229) or CMs (n = 139) in adults in Scotland in 1999–2003, we used annual medical records surveillance, general practitioner follow-up, and patient questionnaires to quantify the risk of seizures between clinical presentation and AVM/CM treatment, last follow-up, or death.Results: The 5-year risk of first-ever seizure after presentation was higher for AVMs presenting with intracranial hemorrhage or focal neurologic deficit (ICH/FND: n = 119; 23{\%}, 95{\%} confidence interval [CI] 9{\%}–37{\%}) than for incidental AVMs (n = 40; 8{\%}, 95{\%} CI 0{\%}–20{\%}), CMs presenting with ICH/FND (n = 38; 6{\%}, 95{\%} CI 0{\%}–14{\%}), or incidental CMs (n = 57; 4{\%}, 95{\%} CI 0{\%}–10{\%}). For adults who had never experienced ICH/FND, the 5-year risk of epilepsy after first-ever seizure was higher for CMs (n = 23; 94{\%}, 95{\%} CI 84{\%}–100{\%}) than AVMs (n = 37; 58{\%}, 95{\%} CI 40{\%}–76{\%}; p = 0.02). Among adults who never experienced ICH/FND and presented with or developed epilepsy, there was no difference in the proportions achieving 2-year seizure freedom over 5 years between AVMs (n = 43; 45{\%}, 95{\%} CI 20{\%}–70{\%}) and CMs (n = 35; 47{\%}, 95{\%} CI 27{\%}–67{\%}).Conclusions: AVM-related ICH confers a significantly higher risk of a first-ever seizure compared to CMs or incidental AVMs. Adults with a CM have a high risk of epilepsy after a first-ever seizure but achieve seizure freedom as frequently as those with epilepsy due to an AVM.",
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AU - Duncan, R.

AU - Roberts, R. C.

AU - Counsell, C. E.

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AU - Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators

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N2 - Objectives: To determine the risk of epileptic seizures due to a brain arteriovenous malformation (AVM) or cavernous malformation (CM).Methods: In a prospective population-based study of new diagnoses of AVMs (n = 229) or CMs (n = 139) in adults in Scotland in 1999–2003, we used annual medical records surveillance, general practitioner follow-up, and patient questionnaires to quantify the risk of seizures between clinical presentation and AVM/CM treatment, last follow-up, or death.Results: The 5-year risk of first-ever seizure after presentation was higher for AVMs presenting with intracranial hemorrhage or focal neurologic deficit (ICH/FND: n = 119; 23%, 95% confidence interval [CI] 9%–37%) than for incidental AVMs (n = 40; 8%, 95% CI 0%–20%), CMs presenting with ICH/FND (n = 38; 6%, 95% CI 0%–14%), or incidental CMs (n = 57; 4%, 95% CI 0%–10%). For adults who had never experienced ICH/FND, the 5-year risk of epilepsy after first-ever seizure was higher for CMs (n = 23; 94%, 95% CI 84%–100%) than AVMs (n = 37; 58%, 95% CI 40%–76%; p = 0.02). Among adults who never experienced ICH/FND and presented with or developed epilepsy, there was no difference in the proportions achieving 2-year seizure freedom over 5 years between AVMs (n = 43; 45%, 95% CI 20%–70%) and CMs (n = 35; 47%, 95% CI 27%–67%).Conclusions: AVM-related ICH confers a significantly higher risk of a first-ever seizure compared to CMs or incidental AVMs. Adults with a CM have a high risk of epilepsy after a first-ever seizure but achieve seizure freedom as frequently as those with epilepsy due to an AVM.

AB - Objectives: To determine the risk of epileptic seizures due to a brain arteriovenous malformation (AVM) or cavernous malformation (CM).Methods: In a prospective population-based study of new diagnoses of AVMs (n = 229) or CMs (n = 139) in adults in Scotland in 1999–2003, we used annual medical records surveillance, general practitioner follow-up, and patient questionnaires to quantify the risk of seizures between clinical presentation and AVM/CM treatment, last follow-up, or death.Results: The 5-year risk of first-ever seizure after presentation was higher for AVMs presenting with intracranial hemorrhage or focal neurologic deficit (ICH/FND: n = 119; 23%, 95% confidence interval [CI] 9%–37%) than for incidental AVMs (n = 40; 8%, 95% CI 0%–20%), CMs presenting with ICH/FND (n = 38; 6%, 95% CI 0%–14%), or incidental CMs (n = 57; 4%, 95% CI 0%–10%). For adults who had never experienced ICH/FND, the 5-year risk of epilepsy after first-ever seizure was higher for CMs (n = 23; 94%, 95% CI 84%–100%) than AVMs (n = 37; 58%, 95% CI 40%–76%; p = 0.02). Among adults who never experienced ICH/FND and presented with or developed epilepsy, there was no difference in the proportions achieving 2-year seizure freedom over 5 years between AVMs (n = 43; 45%, 95% CI 20%–70%) and CMs (n = 35; 47%, 95% CI 27%–67%).Conclusions: AVM-related ICH confers a significantly higher risk of a first-ever seizure compared to CMs or incidental AVMs. Adults with a CM have a high risk of epilepsy after a first-ever seizure but achieve seizure freedom as frequently as those with epilepsy due to an AVM.

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KW - female

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KW - male

KW - middle aged

KW - odds ratio

KW - prevalence

KW - prospective studies

KW - questionnaires

KW - risk

KW - Scotland

KW - seizures

KW - cavernous

KW - central nervous system

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