# Epilepsy Secondary to a Giant AVM: A Case Report

## TL;DR

A woman with a large brain AVM developed seizures that were difficult to control with standard medications, requiring a tailored treatment approach.

## Contribution

This case report highlights the challenges of managing epilepsy caused by giant AVMs and the effectiveness of a combination of antiseizure medications.

## Key findings

- Standard antiseizure medications like carbamazepine and phenytoin failed to control seizures effectively.
- Combination therapy with levetiracetam and carbamazepine provided partial seizure control.
- The case emphasizes the need for personalized treatment strategies in managing epilepsy from giant AVMs.

## Abstract

Intracranial arteriovenous malformations (AVMs) are vascular anomalies that can present with intracranial hemorrhage, seizures, or neurological deficits. In this case, we present a woman with a giant right frontoparietal AVM (Spetzler–Martin Grade V) initially diagnosed after an intracerebral hemorrhage at Age 6. Surgical, endovascular, and radiosurgical treatments were not viable due to the lesion's size and eloquent location. Over time, the patient developed focal seizures, including catamenial patterns and left-arm spastic monoparesis. Initial antiseizure medications (ASMs) such as carbamazepine and phenytoin failed to provide adequate control at optimal dosage, with phenytoin exacerbating seizure frequency. Partial seizure control was eventually achieved with a combination of levetiracetam and carbamazepine. Neuroimaging showcases a large AVM, while EEG revealed focal epileptiform activity. This case illustrates the complexity of treating epilepsy secondary to giant AVMs, emphasizing the need for individualized ASM strategies and collaborative, multidisciplinary management.