Garcia Joseph H, Winkler Ethan A, Morshed Ramin A, Lu Alex, Ammanuel Simon G, Saggi Satvir, Wang Elaina J, Braunstein Steve, Fox Christine K, Fullerton Heather J, Kim Helen, Cooke Daniel L, Hetts Steven W, Lawton Michael T, Abla Adib A, Gupta Nalin
1Department of Neurological Surgery, University of California San Francisco, San Francisco.
2Department of Radiation Oncology, University of California San Francisco, San Francisco.
J Neurosurg Pediatr. 2021 Sep 24;28(6):663-668. doi: 10.3171/2021.6.PEDS21126. Print 2021 Dec 1.
Children with cerebral arteriovenous malformations (AVMs) can present with seizures, potentially increasing morbidity and impacting clinical management. However, the factors that lead to seizures as a presenting sign are not well defined. While AVM-related seizures have been described in case series, most studies have focused on adults and have included patients who developed seizures after an AVM rupture. To address this, the authors sought to analyze demographic and morphological characteristics of AVMs in a large cohort of children.
The demographic, clinical, and AVM morphological characteristics of 189 pediatric patients from a single-center database were studied. Univariate and multivariate logistic regression models were used to test the effect of these characteristics on seizures as an initial presenting symptom in patients with unruptured brain AVMs.
Overall, 28 of 189 patients initially presented with seizures (14.8%). By univariate comparison, frontal lobe location (p = 0.02), larger AVM size (p = 0.003), older patient age (p = 0.04), and the Supplemented Spetzler-Martin (Supp-SM) grade (0.0006) were associated with seizure presentation. Multivariate analysis confirmed an independent effect of frontal lobe AVM location and higher Supp-SM grade. All patients presenting with seizures had AVMs in the cortex or subcortical white matter.
While children and adults share some risk factors for seizure presentation, their risk factor profiles do not entirely overlap. Pediatric patients with cortical AVMs in the frontal lobe were more likely to present with seizures. Additionally, the Supp-SM grade was highly associated with seizure presentation. Future clinical research should focus on the effect of therapeutic interventions targeting AVMs on seizure control in these patients.
患有脑动静脉畸形（AVM）的儿童可能会出现癫痫发作，这可能会增加发病率并影响临床管理。然而，导致癫痫发作作为首发症状的因素尚未明确界定。虽然在病例系列中已经描述了与AVM相关的癫痫发作，但大多数研究都集中在成人身上，并且纳入了在AVM破裂后出现癫痫发作的患者。为了解决这个问题，作者试图分析一大群儿童AVM的人口统计学和形态学特征。
研究了来自单中心数据库的189例儿科患者的人口统计学、临床和AVM形态学特征。使用单变量和多变量逻辑回归模型来测试这些特征对未破裂脑AVM患者癫痫发作作为初始症状的影响。
总体而言，189例患者中有28例最初出现癫痫发作（14.8%）。通过单变量比较，额叶位置（p = 0.02）、较大的AVM大小（p = 0.003）、患者年龄较大（p = 0.04）和补充斯佩茨勒-马丁（Supp-SM）分级（0.0006）与癫痫发作表现相关。多变量分析证实了额叶AVM位置和较高的Supp-SM分级的独立影响。所有出现癫痫发作的患者的AVM均位于皮质或皮质下白质。
虽然儿童和成人在癫痫发作表现方面有一些共同的危险因素，但他们的危险因素并不完全重叠。额叶有皮质AVM的儿科患者更有可能出现癫痫发作。此外，Supp-SM分级与癫痫发作表现高度相关。未来的临床研究应关注针对AVM的治疗干预对这些患者癫痫控制的影响。
