Journal
NEUROLOGY
Volume 79, Issue 6, Pages 500-507Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3182635696
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Funding
- University of Edinburgh
- Medical Research Council [G84/5176, G108/613, G1002605]
- Chief Scientist Office of the Scottish Government [K/MRS/50/C2704, CZB/4/35, CZG/2/419, CZG/2/265]
- United Kingdom Stroke Association [TSA04/01]
- Royal College of Physicians
- Parkinson's UK
- Dystonia Society
- National Institute of Health Research [RP-PG-0707-10124]
- UCB
- Eisai
- Janssen Cilag
- GSK
- Pfizer
- Cyberonics
- Chest Heart and Stroke Scotland
- MRC [G108/613, G1002605] Funding Source: UKRI
- Medical Research Council [G108/613, G1002605] Funding Source: researchfish
- National Institutes of Health Research (NIHR) [RP-PG-0707-10124] Funding Source: National Institutes of Health Research (NIHR)
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Objectives: To compare the risk of epileptic seizures in adults during conservative management or following invasive treatment for a brain arteriovenous malformation (AVM). Methods: We used annual general practitioner follow-up, patient questionnaires, and medical records surveillance to quantify the 5-year risk of seizures and the chances of achieving 2-year seizure freedom for adults undergoing AVM treatment compared to adults managed conservatively in a prospective, population-based observational study of adults in Scotland, newly diagnosed with an AVM in 1999-2003. Results: We identified 229 adults with a new diagnosis of an AVM, of whom two-thirds received AVM treatment (154/229; 67%) during 1,862 person-years of follow-up (median completeness of follow-up 97%). There was no significant difference in the proportions with a first or recurrent seizure over 5 years following AVM treatment, compared to the first 5 years following clinical presentation in conservatively managed adults, in analyses stratified by mode of presentation (intracerebral hemorrhage, 35% vs 26%, p = 0.5; seizure, 67% vs 72%, p = 0.6; incidental, 21% vs 10%, p = 0.4). For patients with epilepsy, the chances of achieving 2-year seizure freedom during 5-year follow-up were similar following AVM treatment (n = 39; 52%, 95% confidence interval [CI] 36% to 68%) or conservative management (n = 21; 57%, 95% CI 35% to 79%; p = 0.7). Conclusions: In this observational study, there was no difference in the 5-year risk of seizures with AVM treatment or conservative management, irrespective of whether the AVM had presented with hemorrhage or epileptic seizures. Neurology (R) 2012;79:500-507
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