Moyamoya Disease: Current Treatment Options and the Role of Medication

Understanding Moyamoya Disease and Its Primary Treatments

Moyamoya disease is a rare, progressive cerebrovascular disorder characterized by the narrowing or blockage of arteries in the brain, leading to reduced blood flow. Over time, this can result in transient ischemic attacks (TIAs), strokes, or hemorrhages, particularly in children and young adults. While the exact cause remains unknown, early diagnosis and intervention are crucial for preventing long-term neurological damage.

Surgical Intervention as the Gold Standard

The most effective treatment for moyamoya disease is surgical revascularization. Among the various surgical techniques, combined bypass procedures—such as direct superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis along with indirect methods like encephaloduroarteriosynangiosis (EDAS)—have shown superior outcomes. These surgeries aim to restore adequate blood supply to the brain by creating new pathways for circulation, significantly reducing the risk of future strokes.

The Limited Role of Medications in Management

Currently, there are no medications that can cure or reverse the underlying vascular changes in moyamoya disease. However, some doctors may prescribe antiplatelet agents such as aspirin or clopidogrel (Plavix) to help manage symptoms and reduce the risk of clot formation in the short term. These drugs may offer temporary benefits, especially in patients experiencing transient neurological episodes.

Why Long-Term Drug Use Is Not Recommended

Despite their initial utility, long-term use of antiplatelet medications is generally not advised. Research indicates that these drugs do not significantly lower the long-term risk of cerebral infarction in moyamoya patients. Moreover, prolonged use increases the potential for bleeding complications, including intracranial hemorrhage—a serious concern given the fragile collateral vessels formed in this condition.

A Comprehensive Approach to Patient Care

Effective management of moyamoya disease involves more than just surgery or medication. A multidisciplinary approach—including neuroimaging follow-ups, lifestyle modifications, and regular neurological assessments—is essential for monitoring disease progression and optimizing outcomes. Patients should work closely with specialized neurovascular teams to determine the best individualized treatment plan based on age, symptom severity, and imaging findings.