Seizure presentation and incidence-associated factors in treated cerebral arteriovenous malformations: a secondary analysis of the MISTA consortium

Daniel Sconzo; Felipe Ramirez-Velandia; Sandeep Muram; Alejandro Enriquez-Marulanda; Nimer Adeeb; Sandeep Kandregula; Hamza Adel Salim; Basel Musmar; Adam A Dmytriw; Douglas Kondziolka; Kareem El Naamani; Jason Sheehan; Natasha Ironside; Salem Tos; Ahmed Abdelsalam; Deepak Kumbhare; Cagdas Ataoglu; Muhammed Amir Essibayi; Abdullah Keles; Howard Riina; Arwin Rezai; Johannes Pöppe; Rajeev D Sen; Christoph J Griessenauer; Pascal Jabbour; Stavropoula I Tjoumakaris; Jan-Karl Burkhardt; Robert M Starke; Ufuk Erginoglu; Mustafa K Baskaya; Laligam N Sekhar; Michael R Levitt; David J Altschul; Malia McAvoy; Assala Aslan; Abdallah Abushehab; Christian Swaid; Adib Abla; Christopher Stapleton; Matthew Koch; Visish M Srinivasan; Peng R Chen; Spiros Blackburn; Mark J Dannenbaum; Omar Choudhri; Bryan Pukenas; Darren Orbach; Edward Smith; Markus Möhlenbruch; Ali Alaraj; Ali Aziz-Sultan; Aman B Patel; Hugo H Cuellar; Michael Lawton; Jacques Morcos; Bharat Guthikonda; Philipp Taussky; Christopher S Ogilvy

doi:10.1007/s10143-025-03337-z

Seizure presentation and incidence-associated factors in treated cerebral arteriovenous malformations: a secondary analysis of the MISTA consortium

Neurosurg Rev. 2025 Feb 22;48(1):263. doi: 10.1007/s10143-025-03337-z.

Authors

Daniel Sconzo^{1

2}, Felipe Ramirez-Velandia^{1

2}, Sandeep Muram^{1

2}, Alejandro Enriquez-Marulanda^{1

2}, Nimer Adeeb^{3

4}, Sandeep Kandregula⁵, Hamza Adel Salim⁶, Basel Musmar⁷, Adam A Dmytriw⁸, Douglas Kondziolka⁹, Kareem El Naamani⁷, Jason Sheehan¹⁰, Natasha Ironside¹⁰, Salem Tos¹⁰, Ahmed Abdelsalam¹¹, Deepak Kumbhare³, Cagdas Ataoglu¹², Muhammed Amir Essibayi¹³, Abdullah Keles¹², Howard Riina⁹, Arwin Rezai¹⁴, Johannes Pöppe¹⁴, Rajeev D Sen¹⁵, Christoph J Griessenauer¹⁴, Pascal Jabbour⁷, Stavropoula I Tjoumakaris⁷, Jan-Karl Burkhardt⁵, Robert M Starke¹¹, Ufuk Erginoglu¹², Mustafa K Baskaya¹², Laligam N Sekhar¹⁵, Michael R Levitt¹⁵, David J Altschul¹³, Malia McAvoy¹⁵, Assala Aslan⁶, Abdallah Abushehab¹⁶, Christian Swaid⁴, Adib Abla¹¹, Christopher Stapleton⁸, Matthew Koch¹⁷, Visish M Srinivasan⁵, Peng R Chen⁴, Spiros Blackburn⁴, Mark J Dannenbaum⁴, Omar Choudhri⁵, Bryan Pukenas⁵, Darren Orbach¹⁸, Edward Smith¹⁹, Markus Möhlenbruch²⁰, Ali Alaraj²¹, Ali Aziz-Sultan²², Aman B Patel⁸, Hugo H Cuellar^{3

6}, Michael Lawton²³, Jacques Morcos⁴, Bharat Guthikonda³, Philipp Taussky^{1

2}, Christopher S Ogilvy^{24

25}

Affiliations

¹ Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² Neurosurgical Service Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA.
³ Department of Neurosurgery, Louisiana State University, Shreveport, LA, USA.
⁴ Department of Neurosurgery, University of Texas at Houston, Houston, TX, USA.
⁵ Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Radiology, Louisiana State University, Shreveport, LA, USA.
⁷ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁸ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MD, USA.
⁹ Department of Neurosurgery, New York University Grossman School of Medicine, New York, NY, USA.
¹⁰ Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
¹¹ Department of Neurosurgery, University of Miami, Miami, FL, USA.
¹² Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, WI, USA.
¹³ Montefiore Einstein Cerebrovascular Research Lab, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁴ Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
¹⁵ Department of Neurosurgery, University of Washington, Seattle, WA, USA.
¹⁶ Department of Plastic Surgery, Mayo Clinic Hospital, Rochester, MN, USA.
¹⁷ Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
¹⁸ Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁹ Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
²⁰ Interventional Neuroradiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
²¹ Department of Neurosurgery, University of Illinois in Chicago, Chicago, IL, USA.
²² Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA.
²³ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
²⁴ Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. cogilvy@bidmc.harvard.edu.
²⁵ Neurosurgical Service Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA. cogilvy@bidmc.harvard.edu.

PMID: 39985590
DOI: 10.1007/s10143-025-03337-z

Abstract

Seizures occur in 20-45% of patients with cerebral arteriovenous malformations (AVMs) and can potentially influence their quality of life. Some studies have suggested risk factors influencing their development, but the evidence is limited to small cohorts. To analyze seizure presentation and factors influencing seizure development in patients with cerebral AVMs using a multi-institutional consortium. Retrospective multicenter registry from multiple centers in North America and Europe of patients aged 1 to 89 years who had undergone any intervention for brain AVMs between January 2010 and December 2023. Demographics, functional assessment (modified Rankin Scale; mRS), and AVM characteristics, were evaluated to assess for relationship with seizures using a multivariate generalized linear mixed-effects model. 1,005 AVM patients were analyzed; the median age was 42, 73% had a baseline mRS ≤ 2. The median nidus size was 2.2 cm, and most AVMs were Spetzler-Martin grade II (37%). Seizure was the presenting symptom in 237 patients (24%). After adjusting for significant variables, patient-specific factors associated with seizures were younger age (OR 0.99, CI95% 0.98-1), male sex (OR 1.65, CI95% 1.18-2.30), and smoking history (OR 1.69, CI95% 1.17-2.44). AVM-specific factors associated with seizures included rupture status (OR 0.42, CI95% 0.30-0.61); eloquent cortex (OR 1.61, CI95% 1.13-2.29); frontal (OR 1.54, CI95% 1.01-2.35), temporal (OR 1.93, CI95% 1.26-2.96) and parietal (OR 1.71 CI95% 1.08-2.71) location; larger nidal size (OR = 1.23, CI95% 1.08-1.39), and superficial draining vein location (OR 1.86, CI95% 1.15-3.01). In this multicenter consortium, after controlling for significant variables, the incidence of AVM-related seizures was associated with younger age, male sex, smoking history, larger AVMs, eloquent locations, and AVMs in the frontal, temporal, and parietal cortices. Conversely, rupture status, deep venous drainage, and cerebellar locations were negatively associated with seizures.

Keywords: Arteriovenous malformations; Presentation; Seizure.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Incidence
Infant
Intracranial Arteriovenous Malformations* / complications
Intracranial Arteriovenous Malformations* / epidemiology
Intracranial Arteriovenous Malformations* / surgery
Male
Middle Aged
Registries* / statistics & numerical data
Retrospective Studies
Risk Factors
Seizures* / epidemiology
Seizures* / etiology
Young Adult