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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Factors associated with seizures at initial presentation in pediatric patients with cerebral arteriovenous
Joseph H Garcia1, Ethan A Winkler1, Ramin A Morshed1
11Department of Neurological Surgery, University of California San Francisco, San Francisco.
Insights
Frontal lobe location and higher Supplemented Spetzler-Martin (Supp-SM) grade are key factors associated with seizures in pediatric cerebral arteriovenous malformations (AVMs). Understanding these factors is crucial for managing AVMs in children.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Seizures are a significant concern in pediatric cerebral arteriovenous malformations (AVMs), impacting patient morbidity and treatment.
- Factors influencing seizures as a presenting symptom in children with AVMs are not well-defined, with limited research focusing on pediatric populations and unruptured AVMs.
Purpose of the Study:
- To investigate the demographic and morphological characteristics of pediatric cerebral arteriovenous malformations (AVMs) associated with seizures as an initial presenting symptom.
- To identify specific AVM features that predict seizure presentation in children with unruptured brain AVMs.
Main Methods:
- A retrospective analysis of 189 pediatric patients with cerebral arteriovenous malformations (AVMs) from a single-center database.
- Univariate and multivariate logistic regression models were employed to assess the association between patient/AVM characteristics and seizure presentation.
Main Results:
- Approximately 14.8% of pediatric patients presented with seizures. Univariate analysis indicated that frontal lobe AVM location, larger AVM size, older patient age, and higher Supplemented Spetzler-Martin (Supp-SM) grade were associated with seizures.
- Multivariate analysis confirmed frontal lobe location and higher Supp-SM grade as independent predictors of seizure presentation in pediatric AVMs. All seizure cases involved cortical or subcortical white matter AVMs.
Conclusions:
- Pediatric AVM seizure presentation differs from adults, with frontal lobe cortical AVMs and higher Supp-SM grades being significant risk factors.
- The Supplemented Spetzler-Martin (Supp-SM) grade is strongly linked to seizure presentation in children with AVMs.
- Further research should explore therapeutic interventions for AVMs and their impact on seizure control in pediatric patients.
Objective:
Children with cerebral arteriovenous malformations (AVMs) can present with seizures, potentially increasing morbidity and impacting clinical management. However, the factors that lead to seizures as a presenting sign are not well defined. While AVM-related seizures have been described in case series, most studies have focused on adults and have included patients who developed seizures after an AVM rupture. To address this, the authors sought to analyze demographic and morphological characteristics of AVMs in a large cohort of children.
Methods:
The demographic, clinical, and AVM morphological characteristics of 189 pediatric patients from a single-center database were studied. Univariate and multivariate logistic regression models were used to test the effect of these characteristics on seizures as an initial presenting symptom in patients with unruptured brain AVMs.
Results:
Overall, 28 of 189 patients initially presented with seizures (14.8%). By univariate comparison, frontal lobe location (p = 0.02), larger AVM size (p = 0.003), older patient age (p = 0.04), and the Supplemented Spetzler-Martin (Supp-SM) grade (0.0006) were associated with seizure presentation. Multivariate analysis confirmed an independent effect of frontal lobe AVM location and higher Supp-SM grade. All patients presenting with seizures had AVMs in the cortex or subcortical white matter.
Conclusions:
While children and adults share some risk factors for seizure presentation, their risk factor profiles do not entirely overlap. Pediatric patients with cortical AVMs in the frontal lobe were more likely to present with seizures. Additionally, the Supp-SM grade was highly associated with seizure presentation. Future clinical research should focus on the effect of therapeutic interventions targeting AVMs on seizure control in these patients.
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