Seizure risk with AVM treatment or conservative management: prospective, population-based study

Colin B Josephson, Jo J Bhattacharya, Carl E Counsell, Vakis Papanastassiou, Vaughn Ritchie, Richard Roberts, Robin Sellar, Charles P Warlow, Rustam Al-Shahi Salman, Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators

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Abstract

Objectives: To compare the risk of epileptic seizures in adults during conservative management or following invasive treatment for a brain arteriovenous malformation (AVM).

Methods: We used annual general practitioner follow-up, patient questionnaires, and medical records surveillance to quantify the 5-year risk of seizures and the chances of achieving 2-year seizure freedom for adults undergoing AVM treatment compared to adults managed conservatively in a prospective, population-based observational study of adults in Scotland, newly diagnosed with an AVM in 1999–2003.

Results: We identified 229 adults with a new diagnosis of an AVM, of whom two-thirds received AVM treatment (154/229; 67%) during 1,862 person-years of follow-up (median completeness of follow-up 97%). There was no significant difference in the proportions with a first or recurrent seizure over 5 years following AVM treatment, compared to the first 5 years following clinical presentation in conservatively managed adults, in analyses stratified by mode of presentation (intracerebral hemorrhage, 35% vs 26%, p = 0.5; seizure, 67% vs 72%, p = 0.6; incidental, 21% vs 10%, p = 0.4). For patients with epilepsy, the chances of achieving 2-year seizure freedom during 5-year follow-up were similar following AVM treatment (n = 39; 52%, 95% confidence interval [CI] 36% to 68%) or conservative management (n = 21; 57%, 95% CI 35% to 79%; p = 0.7).

Conclusions: In this observational study, there was no difference in the 5-year risk of seizures with AVM treatment or conservative management, irrespective of whether the AVM had presented with hemorrhage or epileptic seizures.

Original languageEnglish
Pages (from-to)500-507
Number of pages8
JournalNeurology
Volume79
Issue number6
Early online date3 Jul 2012
DOIs
Publication statusPublished - 7 Aug 2012

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Josephson, C. B., Bhattacharya, J. J., Counsell, C. E., Papanastassiou, V., Ritchie, V., Roberts, R., Sellar, R., Warlow, C. P., Al-Shahi Salman, R., & Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators (2012). Seizure risk with AVM treatment or conservative management: prospective, population-based study. Neurology, 79(6), 500-507. https://doi.org/10.1212/WNL.0b013e3182635696