Demographic and angioarchitectural features associated with seizures presentation in patients with brain arteriovenous malformations in Durban, KwaZulu-Natal, South Africa

Abstract

Background: Brain arteriovenous malformations (AVMs) often present with epileptic seizures which carry standard mortality rate two to three folds higher than in the general population, yet preventative eradication of these lesions remains controversial. The aim of this study was to determine the demographic and angioarchitectural features associated with clinical presentation of seizures in patients with brain AVMs. Methods: We conducted a retrospective chart review of all consecutive patients who presented to three interventional neuroradiology hospitals, with brain AVMs in Kwazulu-Natal, South Africa, over a period of 10years. The demographic and clinical presentations were derived from patient's electronic medical records. Radiological features were determined using axial Computerized Topography (CT) or Magnetic Resonance Imaging (MRI) Scan. Angioarchitectural features were determined from Digital Subtraction Angiography (DSA). Simple and multiple logistic regression models were used to identify factors associated with the risk of seizure as initial presentation in brain AVMs. Results: The analysis identified race/ethnicity, nidus size and location as the predictors of seizure presentation. By multiple logistic regression analysis, African-black race (OR=4.7; 95%CI: 1.15–19.60), brain AVM nidus >3cm in diameter, (OR=4.4; 95%CI: 1.7−11.42) and cortical lobar location (OR=13.6; 95%CI: 2.80−65.14) were found to be significant predictors of brain AVM-associated seizures. Conclusion: Improved knowledge of specific morphological factors associated with brain AVM epilepsy could aid in the formulation of appropriate therapeutic strategies for control and/or cure of these brain AVM-associated seizures. Keywords: Angioarchitecture, Arteriovenous malformations, Brain, Demographics, Seizures