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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.
Footnotes
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Study funding: Supported by the Medical Research Council (Clinical Training Fellowship G84/5176, Clinician Scientist Fellowship G108/613); the Chief Scientist Office of the Scottish Government (grants K/MRS/50/C2704, CZB/4/35, CZG/2/265); and a Project Grant from the United Kingdom Stroke Association (grant TSA04/01). The funders played no role in the decision to submit the article or in its preparation.
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Editorial, page 1540
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Supplemental data at www.neurology.org
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- AED=
- antiepileptic drug;
- AVM=
- arteriovenous malformation;
- CI=
- confidence interval;
- CM=
- cavernous malformation;
- FND=
- focal neurologic deficit;
- ICH=
- intracranial hemorrhage;
- IQR=
- interquartile range;
- IVM=
- intracranial vascular malformation;
- RCT=
- randomized controlled trial;
- SIVMS=
- Scottish IVM Study
- Received October 5, 2010.
- Accepted December 22, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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