title: Cerebral Arteriovenous Malformations and Epilepsy, Part 1: Predictors of Seizure Presentation.
abstract: OBJECTIVE
  Seizures are relatively common in patients harboring cerebral arteriovenous malformations (AVMs). Because the pathogenesis of AVM-associated epilepsy is not well-defined, we aim to determine the factors associated with seizure presentation in AVM patients.
  
  
  METHODS
  We evaluated our institutional AVM radiosurgery database, from 1989-2013, to select patients in whom pertinent clinical information at presentation and adequate clinical and radiologic follow-up was available. Baseline patient demographics and AVM angioarchitectural features were compared between patients with and without seizure presentation. In addition to standard descriptive statistics, logistic regression analyses were performed to identify predictors of seizure presentation.
  
  
  RESULTS
  Of the 1007 AVM patients included for analysis, 229 patients presented with seizures (22.7%). The incidence of seizure presentation was significantly higher in cortical than noncortical AVMs (33.1% vs. 6.6%, P < 0.0001). Among the cortical locations, occipital AVMs had the lowest rate of seizure presentation (21.5%, P = 0.0012), whereas the rates of seizure presentation in frontal (37.3%), temporal (37.7%), and parietal (34.0%) AVMs were similar. The lack of prior AVM hemorrhage (P < 0.0001), larger nidus diameter (P < 0.0001), and cortical location (P < 0.0001) were independent predictors of seizure presentation in the multivariate analysis. The strongest independent predictors of seizure presentation were lack of prior AVM hemorrhage (OR 16.8) and cortical location (OR 4.2).
  
  
  CONCLUSIONS
  Large, unruptured, cortical nidi are most prone to seizure presentation in patients referred for radiosurgery. Further investigations of the molecular biology, neuronal and glial physiology, and natural history of AVM-associated epilepsy appear warranted.
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Quigg
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.affiliation: School of Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Przybylowski
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Blair K
authors.initials: BK
authors.lastname: Dodson
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA. Electronic address: jps2f@virginia.edu.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology; D015331:Cohort Studies; D004827:Epilepsy / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000473:pathology / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D012640:Seizures / Q000209:etiology / Q000473:pathology
keywords: Epilepsy; Intracranial arteriovenous malformations; Neurologic manifestations; Seizures; Vascular malformations