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Principles: The risk of seizures increases in patients with brain tumours (BT) and brain vascular malformations (BVM), but not all risk factors are known. We aimed to identify factors that increase the risk of a first seizure in patients with BT or BVM., Methods: Multicentre case-control study; 102 cases with a first seizure as a presenting symptom of BT or BVM; 121 hospital controls with BT or BVM, but without seizures, matched by centre, gender and age., Results: In the univariate analysis, the risk of first seizure (Odds Ratio, 95% Confidence Limits) was 6.4 (2.3-17.6) for supratentorial lesions, 4.7 (2.4-9.3) for cortical involvement, 2.5 (1.0-7.7) for family history of seizures, and 2.1 (1.2-4.1) for frontal location. The types of lesion with higher risk were low grade glioma (4.7; 1.7-13.9) and cavernous malformations (13.2; 2.1-58.0). After multivariate analysis, including all the imaging characteristics and family history, the strongest independent predictors of first seizure were cortical involvement (OR 4.0; 2.0-8.1) and type of lesion (low grade glioma: 4.0; 1.3-12.8; cavernous malformations: 12.6 (1.5-103.5)., Conclusions: Cortical involvement and type of lesion are the independent risk factors for a first-ever seizure as a presenting symptom of BT or BVM.

Introduction: The risk of seizures increases after stroke, but not all risk factors are known. We aimed to identify factors that increase the risk of a first seizure after a stroke., Methods: Multicenter case-control study of 161 patients with a first seizure after stroke (105 provoked/acute and 56 unprovoked/remote symptomatic) matched to 279 hospital stroke controls by center, gender, age and timing of stroke., Results: The risk of first seizure (odds ratio (OR), 95% confidence limits (CL)) was 3.6 (2.4-5.5) for cortical involvement, 2.5 (1.2-5.3) for multiple CT-scan lesions, 2.4 (1.5-3.9) for supratentorial lesions, 2.4 (1.6-3.7) for prior lesions on CT-scan, 2.1 (1.1-4.7) for family history of seizures, 2.0 (1.1-3.6) for use of epileptogenic drugs, 1.7 (1.0-2.9) for large lesions, 1.6 (1.0-2.8) for hemorrhagic lesions, and 1.4 (1.0-2.2) for cortical atrophy. After multivariate analysis, including all the factors significant in univariate analysis, the strongest independent predictor of a first seizure was cortical involvement (OR 3.3; 95% CL=2.1-5.0), followed by prior lesions (2.2; 1.4-3.4) and hemorrhagic stroke (1.8, 1.0-3.2). The multivariate analysis model for remote symptomatic seizures included cortical involvement, large size, and prior lesions; the model for acute seizures included cortical involvement, alcohol consumption >50 g/day, hemorrhagic stroke, and prior lesions on CT-scan., Discussion: Cortical involvement, the presence of prior lesions on CT-scan, and hemorrhagic lesion are the most important risk factors for a first-ever seizure after stroke.

The aim of this report is to describe the state of the art of quality of life (QoL) instruments used for adults with epilepsy and to help those in the field to identify, select, and use the instruments most suitable for their purposes. We searched Medline and the Cochrane Database for articles in English, German, French, Spanish, Portuguese and Italian published by the end of 2002. Electronic retrieval was completed by hand-search. The final list included 203 articles reporting 205 studies. There were 62 validation studies and 143 clinical studies, including 7 population studies, 45 "pure" observational, 37 observational with aspects of validation and 54 experimental (38 randomized clinical trials and 16 non-randomized or non-controlled trials). Twenty-four generic and 21 specific QoL instruments were used. Eight were used in more than 10 studies, while 21 were used only once; 7/24 generic and 19/21 specific questionnaires were validated for epilepsy. The different domains considered in the 26 questionnaires specifically validated for epilepsy are listed. We classified questionnaires according to three aspects: validation, diffusion of use, and specificity of domains. Questionnaires covering all three aspects (WPSI, ESI-55, QOLIE-89, QOLIE-31, QOLIE-10, Liverpool Batteries) should be preferred when planning a QoL study in epilepsy. However, those covering only two aspects (SF-36, SEALS, EPSES, EOS, PESOS, QOLAS) could also be useful in selected situations or may become a first-choice instrument in the future, after more widespread use or complete validation. All the other instruments should at present be considered only for second choice.