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. 2011 May 3;76(18):1548-54.
doi: 10.1212/WNL.0b013e3182190f37.

Seizure risk from cavernous or arteriovenous malformations: prospective population-based study

C B Josephson  1 , 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
Affiliations

Seizure risk from cavernous or arteriovenous malformations: prospective population-based study

C B Josephson et al. Neurology. .

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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Figures

Figure 1
Figure 1. Five-year risk of a first-ever unprovoked seizure
The 5-year risk of a first-ever unprovoked seizure for adults with an arteriovenous malformation (AVM) or cavernous malformation (CM), who had no prior history of seizures. Analyses are stratified by whether the CM or AVM was an incidental discovery or whether it was diagnosed because of an intracerebral hemorrhage or focal neurologic deficit (ICH/FND). Seizure outcome was statistically significantly different only when comparing AVM presenting with ICH/FND to either CM presenting with ICH/FND (p = 0.04) or AVM detected incidentally (p = 0.046).
Figure 2
Figure 2. Five-year risk of developing epilepsy after a first-ever unprovoked seizure
The 5-year risk of developing epilepsy in patients with an arteriovenous malformation (AVM; solid line) or cavernous malformation (CM; broken line) following a first-ever seizure.
Figure 3
Figure 3. Chance of achieving 2-year seizure freedom for adults over 5 years follow-up
The chance of achieving 2-year seizure freedom for adults with epilepsy due to an arteriovenous malformation (AVM; solid line) or cavernous malformation (CM; broken line).
See this image and copyright information in PMC

Comment in

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