title: Seizure risk with AVM treatment or conservative management: prospective, population-based study.
abstract: OBJECTIVE
  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.
authors: Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.
authors: Colin B
authors: CB
authors: Josephson
authors: Jo J
authors: JJ
authors: Bhattacharya
authors: Carl E
authors: CE
authors: Counsell
authors: Vakis
authors: V
authors: Papanastassiou
authors: Vaughn
authors: V
authors: Ritchie
authors: Richard
authors: R
authors: Roberts
authors: Robin
authors: R
authors: Sellar
authors: Charles P
authors: CP
authors: Warlow
authors: Rustam
authors: R
authors: Al-Shahi Salman
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016634:Radiosurgery / Q000009:adverse effects; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology*