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Research paper
Brain arteriovenous malformations and seizures: an Italian study
  1. F Galletti1,2,3,
  2. C Costa1,
  3. L M Cupini4,
  4. P Eusebi3,5,
  5. M Hamam6,
  6. N Caputo7,
  7. S Siliquini1,
  8. C Conti8,
  9. E Moschini2,
  10. P Lunardi9,
  11. S Carletti2,8,
  12. P Calabresi1,3
  1. 1Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
  2. 2Neurologia, Ospedale S Maria di Terni, Terni, Italy
  3. 3Fondazione S Lucia IRCCS di Roma, Roma, Italy
  4. 4Neurologia, Ospedale S Eugenio di Roma, Roma, Italy
  5. 5Assessorato alla Sanità, Regione Umbria, Italy
  6. 6Neuroradiologia, Ospedale S Maria della Misericordia di Perugia, Perugia, Italy
  7. 7Neuroradiologia, Ospedale S Maria di Terni, Terni, Italy
  8. 8Neurochirurgia, Ospedale S Maria di Terni, Terni, Italy
  9. 9Clinica Neurochirurgia, Università degli Studi di Perugia, Perugia, Italy
  1. Correspondence to Professor Paolo Calabresi, Clinica Neurologica, Università di Perugia, Ospedale S Maria della Misericordia, 06156—S Andrea delle Fratte, Perugia, Italy; calabre{at}unipg.it

Abstract

Objective To evaluate seizures as first clinical manifestation of brain arteriovenous malformations (AVMs), in relation to angioarchitectural features of these vascular anomalies.

Methods We performed a prospective observational study, collecting records of patients with AVMs consecutively admitted to the Neurological and Neurosurgery Units of Perugia University and to the Neurosurgery Unit of Terni Hospital, during a 10-year period (1 January 2002 to 1 June 2012). Two groups of patients, with or without seizures as AVM first presentation, were analysed to identify differences in demographic and angiographic features. A multivariate logistic regression model was also developed.

Results We examined 101 patients with AVMs, 55 male and 46 female. Seizures were the initial clinical manifestation in 31 (30.7%) patients. We found a significant difference (p<0.05) between two groups of patients, with or without seizures as AVM first presentation concerning location, side, topography and venous drainage. A multivariate logistic regression model showed that clinical presentation with seizures was correlated with a location in the temporal and frontal lobes, and with a superficial topography. The strongest association (OR 3.48; 95% CI 1.77 to 6.85) was observed between seizures and AVM location in the temporal lobe.

Conclusions Vascular remodelling and haemodynamic changes of AVMs might create conditions for epileptogenesis. However, here we show that malformations with specific angiographic characteristics are more likely to be associated with seizures as first clinical presentation. Location is the most important feature related to epilepsy and in particular the temporal lobe might play a crucial role in the occurrence of seizure.

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