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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Seizure risk from cavernous or arteriovenous malformations: prospective population-based study.
C B Josephson1, J-P Leach, R Duncan
1Bramwell Dott Building, Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU.
Neurology
|May 4, 2011
Summary
Brain arteriovenous malformations (AVMs) with hemorrhage carry a higher seizure risk than cavernous malformations (CMs). Adults with CMs have a high epilepsy risk after a seizure but achieve seizure freedom similarly to AVM patients.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Brain arteriovenous malformations (AVMs) and cavernous malformations (CMs) are vascular anomalies that can lead to neurological complications.
- Epileptic seizures are a common manifestation of these lesions, impacting patient quality of life and prognosis.
Purpose of the Study:
- To investigate and compare the risk of epileptic seizures in adults diagnosed with brain AVMs or CMs.
- To determine the incidence of seizures from clinical presentation to treatment or death in a population-based cohort.
Main Methods:
- A prospective, population-based study was conducted in Scotland from 1999 to 2003.
- New diagnoses of AVMs (n=229) and CMs (n=139) in adults were followed using medical records, GP follow-up, and questionnaires.
- Seizure risk was quantified between presentation and intervention, last follow-up, or death.
Main Results:
- The 5-year risk of a first seizure was higher for AVMs presenting with intracranial hemorrhage/focal neurologic deficit (23%) compared to incidental AVMs (8%), CMs with ICH/FND (6%), and incidental CMs (4%).
- For individuals without prior ICH/FND, the 5-year epilepsy risk after a first seizure was significantly higher for CMs (94%) than AVMs (58%).
- Among patients with epilepsy and no prior ICH/FND, 5-year seizure freedom rates were similar for AVMs (45%) and CMs (47%).
Conclusions:
- AVMs presenting with intracranial hemorrhage pose a substantially greater risk of a first-ever seizure compared to CMs or incidental AVMs.
- Adults with CMs face a high risk of developing epilepsy after an initial seizure but achieve seizure control rates comparable to those with AVM-related epilepsy.
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