From the Guidelines
Anti-seizure medications are indicated in arteriovenous malformations (AVMs) primarily for patients who have experienced seizures as a symptom of their AVM, which occurs in approximately 20% to 25% of cases 1.
Indication for Anti-Seizure Medication
The primary indication for anti-seizure medication in AVM patients is a history of seizures, which can be either focal or generalized and may indicate the location of the lesion 1.
Treatment Approach
These medications are not routinely prescribed for all AVM patients but are specifically used for those with a seizure history or those at high risk for seizures. The choice of anti-seizure medication should be based on the patient's specific condition, side effect profiles, and potential drug interactions.
Common Anti-Seizure Medications
Common anti-seizure medications that may be used include levetiracetam (Keppra), carbamazepine (Tegretol), lamotrigine (Lamictal), and valproic acid (Depakote) 1. The dosing and duration of treatment should be individualized based on the patient's response and the presence of any side effects.
Rationale for Treatment
The rationale for using these medications is that AVMs can disrupt normal brain electrical activity through various mechanisms, including hemorrhage, ischemia, or direct pressure on surrounding brain tissue 1. Even after AVM treatment, anti-seizure medications are often continued for at least 1-2 years due to the risk of seizures from residual tissue changes.
Key Considerations
- Patient Selection: Medications are specifically used for those with a seizure history or those at high risk for seizures.
- Medication Choice: Should consider side effect profiles, drug interactions, and patient-specific factors.
- Treatment Duration: Typically continues long-term, especially if seizures have occurred, and may be considered for lifelong use in patients with persistent AVMs.
From the Research
Indication of Anti-Seizure Medication in Arteriovenous Malformation (AVM)
- The indication of anti-seizure medication in AVM is primarily for patients who present with seizures as a symptom of their condition 2, 3, 4.
- Seizures are a common symptom of supratentorial AVMs, and uncontrolled epilepsy can considerably reduce patient quality of life 4.
- According to a study, 30% of patients with supratentorial AVMs experienced preoperative seizures, and 18% with seizures progressed to medically refractory epilepsy 4.
- Factors associated with preoperative seizures in AVM patients include a history of AVM hemorrhage, male sex, and frontotemporal lesion location 4.
- Anti-seizure medication may be prescribed as part of the management plan for AVM patients with seizures, with the goal of achieving freedom from seizures and improving patient quality of life 3, 4.
- The treatment plan for AVM patients with seizures should be individualized and based on interdisciplinary discussion between neurosurgery, endovascular neuroradiology, and radiotherapy, moderated by neurology in an experienced center 3.