LAUSR

BACKGROUND Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first-seizure presentation without associated CM hemorrhage. METHODS We queried a prospective registry of consecutive patients with CM established since January 2015. Data regarding clinical presentation, comorbid conditions, daily medication use, and radiologic CM characteristics were collected. Univariate and multivariate regression analysis was performed assessing variables for presentation with seizure without hemorrhage with p value, odds ratio and 95% confidence intervals reported. RESULTS Of 202 patients, 58.4% were female, and the average age at diagnosis was 43.7 +/-16.5 years. 59.4% of patients were symptomatic, and in 40.6%, the CM was an incidental finding. Of the 30 patients who presented with a first-time seizure without concomitant hemorrhage, the mean age at diagnosis was 38.4 +/-14.6 years, and 56.7% were female. Compared to incidental CM, patients with seizure without hemorrhage were younger, had a cortically based, supratentorial lesion, and were less likely to have chronic inflammatory disease or to use aspirin, vitamin D, or statin. Compared to other supratentorial lesions, patients with seizure without hemorrhage more commonly had a temporal lobe CM. CONCLUSION These prospective data provide possible clues to radiologic factors, clinical comorbidity, and medication influences on seizure presentation in patients with CM. Further multi-center studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful.