title: Epileptogenicity of cavernomas depends on (archi-) cortical localization.
abstract: BACKGROUND
  Patients with cerebral cavernomas have an estimated risk of the development of epilepsy of 1.5% to 2.4% per patient-year.
  
  
  OBJECTIVE
  To clarify the predictive value of different risk factors for epilepsy in patients with supratentorial cavernomas.
  
  
  METHODS
  We retrospectively analyzed data of 109 patients with supratentorial cavernomas. The correlation of epilepsy with the variables of single or multiple cavernomas, sex, age, side, cortical involvement, mesiotemporal archicortical vs neocortical involvement, lobar location of neocortical cavernomas, the presence of a hemosiderin rim and of edema, and the maximal diameters of cavernoma, hemosiderin rim, and edema, if present, were calculated using univariate and multivariate penalized likelihood logistic regression models.
  
  
  RESULTS
  Cortical involvement was the most relevant risk factor for epilepsy (P < .0001). No patient with a subcortical cavernoma presented with epilepsy. Epilepsy was more common in patients with mesiotemporal archicortical cavernomas than in patients with neocortical cavernomas (P = .02), whereas the lobar location of neocortical cavernomas was not significantly associated with the risk of the development of epilepsy. In the multivariate analysis, a greater diameter of the cavernoma, the absence of edema, and localization in the left hemisphere were also associated with the occurrence of epilepsy (P < .05).
  
  
  CONCLUSIONS
  The epileptogenicity of supratentorial cavernomas depends on cortical, especially mesiotemporal archicortical, involvement. Exclusively subcortical cavernomas are highly unlikely to cause epilepsy. This information is helpful in counseling patients with cavernomas regarding their risk of epileptic seizures and in patients with multiple cavernomas and epilepsy to generate a valid hypothesis of which cavernoma may cause epilepsy.
authors.affiliation: Interdisciplinary Epilepsy Center, Department of Neurology, University of Marburg, Marburg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Menzler
authors.forename: Xu
authors.initials: X
authors.lastname: Chen
authors.forename: Patricia
authors.initials: P
authors.lastname: Thiel
authors.forename: Joanna
authors.initials: J
authors.lastname: Iwinska-Zelder
authors.forename: Dorothea
authors.initials: D
authors.lastname: Miller
authors.forename: Alexander
authors.initials: A
authors.lastname: Reuss
authors.forename: Hajo M
authors.initials: HM
authors.lastname: Hamer
authors.forename: Janine
authors.initials: J
authors.lastname: Reis
authors.forename: Axel
authors.initials: A
authors.lastname: Pagenstecher
authors.forename: Susanne
authors.initials: S
authors.lastname: Knake
authors.forename: Helmut
authors.initials: H
authors.lastname: Bertalanffy
authors.forename: Felix
authors.initials: F
authors.lastname: Rosenow
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000150:complications*; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000209:etiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult