Symptomatic Cavernous Malformation Presenting with Seizure without Hemorrhage: Analysis of Factors Influencing Clinical Presentation

Edoardo Agosti, Kelly Flemming, Giuseppe Lanzino

Research output: Contribution to journalArticle

Abstract

Background: Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage. Methods: We queried a prospective registry of consecutive patients with CM established in January 2015. Data regarding clinical presentation, comorbid conditions, daily medication use, and radiologic CM characteristics were collected. Univariate and multivariate regression analysis was performed assessing variables for presentation with seizure without hemorrhage with P values, odds ratios, and 95% confidence intervals reported. Results: Of 202 patients, 58.4% were women, and the average age at diagnosis was 43.7 ± 16.5 years. Of the patients, 59.4% were symptomatic. In 40.6%, the CM was an incidental finding. Of the 30 patients who presented with a first-time seizure without concomitant hemorrhage, the mean age at diagnosis was 38.4 ± 14.6 years, and 56.7% were women. Compared with incidental CM, patients with seizure without hemorrhage were younger, had a cortically based, supratentorial lesion, and were less likely to have chronic inflammatory disease or to use aspirin, vitamin D, or statin. Compared with other supratentorial lesions, patients with seizure without hemorrhage more commonly had a temporal lobe CM. Conclusions: These prospective data provide possible clues to radiologic factors, clinical comorbidities, and medication influences on seizure presentation in patients with CM. Further multicenter studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful.

Original languageEnglish (US)
Pages (from-to)e387-e392
JournalWorld neurosurgery
Volume129
DOIs
StatePublished - Sep 1 2019

Fingerprint

Statistical Factor Analysis
Seizures
Hemorrhage
Comorbidity
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Incidental Findings
Temporal Lobe
Vitamin D
Aspirin
Multicenter Studies
Registries
Chronic Disease
Multivariate Analysis
Odds Ratio
Regression Analysis
Confidence Intervals

Keywords

  • Cavernoma
  • Cavernous malformation
  • Clinical presentation
  • Seizure

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Symptomatic Cavernous Malformation Presenting with Seizure without Hemorrhage : Analysis of Factors Influencing Clinical Presentation. / Agosti, Edoardo; Flemming, Kelly; Lanzino, Giuseppe.

In: World neurosurgery, Vol. 129, 01.09.2019, p. e387-e392.

Research output: Contribution to journalArticle

@article{182d0723abe94e72a93679fd1d03effc,
title = "Symptomatic Cavernous Malformation Presenting with Seizure without Hemorrhage: Analysis of Factors Influencing Clinical Presentation",
abstract = "Background: Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage. Methods: We queried a prospective registry of consecutive patients with CM established in January 2015. Data regarding clinical presentation, comorbid conditions, daily medication use, and radiologic CM characteristics were collected. Univariate and multivariate regression analysis was performed assessing variables for presentation with seizure without hemorrhage with P values, odds ratios, and 95{\%} confidence intervals reported. Results: Of 202 patients, 58.4{\%} were women, and the average age at diagnosis was 43.7 ± 16.5 years. Of the patients, 59.4{\%} were symptomatic. In 40.6{\%}, the CM was an incidental finding. Of the 30 patients who presented with a first-time seizure without concomitant hemorrhage, the mean age at diagnosis was 38.4 ± 14.6 years, and 56.7{\%} were women. Compared with incidental CM, patients with seizure without hemorrhage were younger, had a cortically based, supratentorial lesion, and were less likely to have chronic inflammatory disease or to use aspirin, vitamin D, or statin. Compared with other supratentorial lesions, patients with seizure without hemorrhage more commonly had a temporal lobe CM. Conclusions: These prospective data provide possible clues to radiologic factors, clinical comorbidities, and medication influences on seizure presentation in patients with CM. Further multicenter studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful.",
keywords = "Cavernoma, Cavernous malformation, Clinical presentation, Seizure",
author = "Edoardo Agosti and Kelly Flemming and Giuseppe Lanzino",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2019.05.157",
language = "English (US)",
volume = "129",
pages = "e387--e392",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Symptomatic Cavernous Malformation Presenting with Seizure without Hemorrhage

T2 - Analysis of Factors Influencing Clinical Presentation

AU - Agosti, Edoardo

AU - Flemming, Kelly

AU - Lanzino, Giuseppe

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage. Methods: We queried a prospective registry of consecutive patients with CM established in January 2015. Data regarding clinical presentation, comorbid conditions, daily medication use, and radiologic CM characteristics were collected. Univariate and multivariate regression analysis was performed assessing variables for presentation with seizure without hemorrhage with P values, odds ratios, and 95% confidence intervals reported. Results: Of 202 patients, 58.4% were women, and the average age at diagnosis was 43.7 ± 16.5 years. Of the patients, 59.4% were symptomatic. In 40.6%, the CM was an incidental finding. Of the 30 patients who presented with a first-time seizure without concomitant hemorrhage, the mean age at diagnosis was 38.4 ± 14.6 years, and 56.7% were women. Compared with incidental CM, patients with seizure without hemorrhage were younger, had a cortically based, supratentorial lesion, and were less likely to have chronic inflammatory disease or to use aspirin, vitamin D, or statin. Compared with other supratentorial lesions, patients with seizure without hemorrhage more commonly had a temporal lobe CM. Conclusions: These prospective data provide possible clues to radiologic factors, clinical comorbidities, and medication influences on seizure presentation in patients with CM. Further multicenter studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful.

AB - Background: Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage. Methods: We queried a prospective registry of consecutive patients with CM established in January 2015. Data regarding clinical presentation, comorbid conditions, daily medication use, and radiologic CM characteristics were collected. Univariate and multivariate regression analysis was performed assessing variables for presentation with seizure without hemorrhage with P values, odds ratios, and 95% confidence intervals reported. Results: Of 202 patients, 58.4% were women, and the average age at diagnosis was 43.7 ± 16.5 years. Of the patients, 59.4% were symptomatic. In 40.6%, the CM was an incidental finding. Of the 30 patients who presented with a first-time seizure without concomitant hemorrhage, the mean age at diagnosis was 38.4 ± 14.6 years, and 56.7% were women. Compared with incidental CM, patients with seizure without hemorrhage were younger, had a cortically based, supratentorial lesion, and were less likely to have chronic inflammatory disease or to use aspirin, vitamin D, or statin. Compared with other supratentorial lesions, patients with seizure without hemorrhage more commonly had a temporal lobe CM. Conclusions: These prospective data provide possible clues to radiologic factors, clinical comorbidities, and medication influences on seizure presentation in patients with CM. Further multicenter studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful.

KW - Cavernoma

KW - Cavernous malformation

KW - Clinical presentation

KW - Seizure

UR - http://www.scopus.com/inward/record.url?scp=85067657553&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067657553&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.05.157

DO - 10.1016/j.wneu.2019.05.157

M3 - Article

C2 - 31132505

AN - SCOPUS:85067657553

VL - 129

SP - e387-e392

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -