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Incidence and risk factors associated with seizures in cerebral amyloid angiopathy

Brin E Freund1, Sofia S Sanchez-Boluarte2, Karen Blackmon3

  • 1Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.

European Journal of Neurology
|May 31, 2023
PubMed

Insights

Seizures occur in nearly 20% of cerebral amyloid angiopathy (CAA) patients, often presenting as the first symptom. Lobar intracranial hemorrhage, CAA with inflammation, and superficial siderosis are key risk factors for seizures in CAA.

Area of Science:

  • Neurology
  • Neuroscience
  • Cerebrovascular Diseases

Background:

  • Cerebral amyloid angiopathy (CAA) is a significant cause of intracranial hemorrhage (ICH).
  • Seizures are a known complication of ICH, but their incidence and risk factors in diverse CAA patient cohorts remain understudied.

Purpose of the Study:

  • To investigate the incidence and identify risk factors for seizures in a heterogeneous cohort of patients diagnosed with cerebral amyloid angiopathy (CAA).
  • To analyze clinical features and comorbidities associated with seizures in CAA patients.

Main Methods:

  • Retrospective study of 284 patients with CAA (defined by modified Boston criteria v2.0) at Mayo Clinic Florida (2015-2021).
  • Analysis of clinical features, including lobar ICH, cortical/convexity subarachnoid hemorrhage (cSAH), superficial siderosis, and CAA with inflammation (CAA-ri).
  • Univariate and multivariate analyses were performed to determine seizure risk factors.

Main Results:

  • 19.7% of CAA patients experienced seizures, with 37.5% of these seizures being the initial diagnostic feature.
  • Seizures were more frequent in females and associated with lobar ICH, cSAH, superficial siderosis, and CAA-ri.
  • Lobar ICH (OR 2.1), CAA-ri (OR 3.8), and superficial siderosis (OR 3.7) were independently linked to increased seizure risk after adjusting for age and sex.

Conclusions:

  • Seizures are a common occurrence in patients with cerebral amyloid angiopathy.
  • Lobar intracranial hemorrhage, CAA with inflammation, and superficial siderosis are independent predictors of seizures in CAA.
  • These findings can inform optimized clinical monitoring and management strategies for patients with CAA.
Abstract

Keywords:
cerebral amyloid angiopathydementiaintracranial hemorrhageseizuresubarachnoid hemorrhagesuperficial siderosis

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