Seizures, epilepsy, and vascular malformations

Few epidemiologic studies characterize seizures and epilepsy in people with vascular malformations. In the current issue of Neurology ®, Josephson and colleagues1 report on the frequency and prognosis of seizures and epilepsy occurring in residents of Scotland age 16 and over with a diagnosis of either brain arteriovenous malformations (AVM) or cavernous malformations (CM). A strength of the study was the use of prospectively collected data from the Scottish Intracranial Vascular Malformation Study (SIVMS 1999–2003) and from the Scottish Audit of Intracranial Vascular Malformations (SAIVMs 2006–2010). These 2 entities account for 75% of incident intracranial vascular malformations in the Scottish population.2 While the risk of intracerebral bleeding remains a primary concern, a substantial proportion of these people will have seizures or develop epilepsy. In the present prospective population-based study, AVM and CM differ in both presentation and risk for epilepsy. Approximately 25% of people with each condition presented with epilepsy. For AVM, an additional 50% were identified because of hemorrhage or the development of focal neurologic deficits. For CM, approximately 50% were identified as …