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Incidence and risk factors of epilepsy following brain arteriovenous malformation rupture in adult patients

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Abstract

Background

Little is known about incidence, time of onset, clinical presentation, and risk factors of epileptic seizure following brain arteriovenous malformation (bAVM) rupture.

Methods

We performed a monocentric retrospective cohort study from January 2003 to March 2021. The main objective of this study was to determine the incidence of seizures after spontaneous bAVM rupture in nonepileptic adult patients and describe the corresponding clinical features. The secondary objective was to identify clinical, radiological, or biological predictors for the occurrence of de novo seizures after bAVM rupture.

Results

Of the 296 cases of bAVM rupture registered during the study period, 247 nonepileptic patients (male 53%, median age 40) were included in the study. Fifty-nine patients (23.9%) had at least one seizure after bAVM rupture. The use of preventive antiepileptic drugs (10.3 [1.5–74.1]; P = 0.02) and decompressive craniectomy (15.4 [2.0–125]; P < 0.009) were independently associated with the occurrence of epilepsy after the bAVM rupture. The factors independently associated with the absence of any seizure after the rupture were isolated intraventricular hemorrhage (0.3 [0.1–0.99]; P = 0.04) and infratentorial location of the bAVM (0.2 [0.1–0.5]; P = 0.09). The first seizure occurred within the first year or within 5 years in, respectively, 83.1% and 98.3% of the patients.

Conclusions

Epilepsy affects nearly a quarter of patients after bAVM rupture. Decompressive craniectomy represents an independent risk factor significantly associated with the occurrence of epilepsy after bAVM rupture. The introduction of preventive AEDs after rupture could be considered in these most severe patients who have a decompressive craniectomy.

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France

    Gonzague Guillaumet, Aurélien Nouet, Alexandre Carpentier & Bertrand Mathon

  2. Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France

    Eimad Shotar, Frédéric Clarençon, Nader-Antoine Sourour, Kevin Premat & Stéphanie Lenck

  3. Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France

    Sophie Dupont

  4. Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France

    Alice Jacquens & Vincent Degos

  5. Department of Vascular and Oncological Interventional Radiology, AP-HP, Centre, Hôpital Européen Georges-Pompidou, 75015, Paris, France

    Tom Boeken

  6. Université de Paris, 75006, Paris, France

    Tom Boeken

  7. ICM, INSERM U 1127, CNRS UMR 7225, UMRS 1127, Paris Brain Institute, Sorbonne University, 75013, Paris, France

    Bertrand Mathon

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  1. Gonzague Guillaumet
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  2. Eimad Shotar
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  3. Frédéric Clarençon
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  9. Vincent Degos
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  13. Bertrand Mathon
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Contributions

All authors had access to the data and a role in writing the manuscript. BM completed the statistical analysis.

Corresponding author

Correspondence to Bertrand Mathon.

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Conflicts of interest

Prof. Frédéric Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core laboratory; non-related to the study) and Artedrone (board member). The other authors have no conflict of interest to disclose.

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Guillaumet, G., Shotar, E., Clarençon, F. et al. Incidence and risk factors of epilepsy following brain arteriovenous malformation rupture in adult patients. J Neurol 269, 6342–6353 (2022). https://doi.org/10.1007/s00415-022-11286-6

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