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

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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.
Original languageEnglish
Pages (from-to)1548-1554
Number of pages7
JournalNeurology
Volume76
Issue number18
DOIs
Publication statusPublished - 3 May 2011

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

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    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