Epilepsy Secondary to a Giant AVM: A Case Report.

Area of Science:

• Neurology
• Neurosurgery
• Vascular Neurology

Background:

• Intracranial arteriovenous malformations (AVMs) are complex vascular anomalies.
• Giant AVMs, particularly those in eloquent brain regions, pose significant treatment challenges.
• Epilepsy is a common neurological deficit associated with intracranial AVMs.

Observation:

• A case of a Spetzler-Martin Grade V giant right frontoparietal AVM is presented.
• The patient experienced intracerebral hemorrhage at age 6, followed by focal seizures and left-arm spastic monoparesis.
• Standard surgical, endovascular, and radiosurgical interventions were not feasible due to the AVM's size and location.

Findings:

• Initial antiseizure medications (ASMs) like carbamazepine and phenytoin were ineffective, with phenytoin worsening seizure frequency.
• Partial seizure control was achieved using a combination of levetiracetam and carbamazepine.
• Neuroimaging confirmed the large AVM, and EEG demonstrated focal epileptiform activity.

Implications:

• Treating epilepsy secondary to giant AVMs requires individualized ASM selection.
• Multidisciplinary collaboration is crucial for managing complex neurological cases involving AVMs.
• This case underscores the need for tailored therapeutic approaches in neurovascular disorders with comorbid epilepsy.