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Guillaumet G, Shotar E, Clarençon F, Sourour NA, Premat K, Lenck S, Dupont S, Jacquens A, Degos V, Boeken T, Nouet A, Carpentier A, Mathon B. Incidence and risk factors of epilepsy following brain arteriovenous malformation rupture in adult patients. J Neurol 2022; 269:6342-6353. [PMID: 35867151 DOI: 10.1007/s00415-022-11286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
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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Affiliation(s)
- Gonzague Guillaumet
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Eimad Shotar
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Kevin Premat
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sophie Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alice Jacquens
- Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Vincent Degos
- Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, AP-HP, Centre, Hôpital Européen Georges-Pompidou, 75015, Paris, France.,Université de Paris, 75006, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Alexandre Carpentier
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France. .,ICM, INSERM U 1127, CNRS UMR 7225, UMRS 1127, Paris Brain Institute, Sorbonne University, 75013, Paris, France.
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Kerr WT, Lee JK, Karimi AH, Tatekawa H, Hickman LB, Connerney M, Sreenivasan SS, Dubey I, Allas CH, Smith JM, Savic I, Silverman DHS, Hadjiiski LM, Beimer NJ, Stacey WC, Cohen MS, Engel J, Feusner JD, Salamon N, Stern JM. A minority of patients with functional seizures have abnormalities on neuroimaging. J Neurol Sci 2021; 427:117548. [PMID: 34216975 DOI: 10.1016/j.jns.2021.117548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Functional seizures often are managed incorrectly as a diagnosis of exclusion. However, a significant minority of patients with functional seizures may have abnormalities on neuroimaging that typically are associated with epilepsy, leading to diagnostic confusion. We evaluated the rate of epilepsy-associated findings on MRI, FDG-PET, and CT in patients with functional seizures. METHODS We studied radiologists' reports from neuroimages at our comprehensive epilepsy center from a consecutive series of patients diagnosed with functional seizures without comorbid epilepsy from 2006 to 2019. We summarized the MRI, FDG-PET, and CT results as follows: within normal limits, incidental findings, unrelated findings, non-specific abnormalities, post-operative study, epilepsy risk factors (ERF), borderline epilepsy-associated findings (EAF), and definitive EAF. RESULTS Of the 256 MRIs, 23% demonstrated ERF (5%), borderline EAF (8%), or definitive EAF (10%). The most common EAF was hippocampal sclerosis, with the majority of borderline EAF comprising hippocampal atrophy without T2 hyperintensity or vice versa. Of the 87 FDG-PETs, 26% demonstrated borderline EAF (17%) or definitive EAF (8%). Epilepsy-associated findings primarily included focal hypometabolism, especially of the temporal lobes, with borderline findings including subtle or questionable hypometabolism. Of the 51 CTs, only 2% had definitive EAF. SIGNIFICANCE This large case series provides further evidence that, while uncommon, EAF are seen in patients with functional seizures. A significant portion of these abnormal findings are borderline. The moderately high rate of these abnormalities may represent framing bias from the indication of the study being "seizures," the relative subtlety of EAF, or effects of antiseizure medications.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Brian Hickman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Internal Medicine, University of California at Irvine, Irvine, CA, USA
| | - Michael Connerney
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Ishita Dubey
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Corinne H Allas
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jena M Smith
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Daniel H S Silverman
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas J Beimer
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - William C Stacey
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mark S Cohen
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Departments of Bioengineering, Psychology and Biomedical Physics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Noriko Salamon
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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