Vagus nerve stimulation for drug-resistant Epilepsia Partialis Continua: Report of four cases

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• 作者：Aless ; ro De Benedictis ; Elena Freri ; Michele Rizzi ; Angelo Franzini ; Francesca Ragona ; Nicola Specchio ; Erika Rebessi ; Marina Casazza ; Tiziana Granata ; Carlo Efisio Marras
• 关键词：EPC ; Epilepsia Partialis Continua ; VNS ; vagus nerve stimulation ; RE ; Rasmussen's encephalitis ; ACDs ; anticonvulsant drugs ; SE ; status epilepticus ; MDZ ; midazolam ; CBZ ; carbamazepine ; OXC ; oxcarbamazepine ; TPM ; topiramate ; LVT ; leviracetam ; VPA ; valproic acid ; PHT ; phenitoyne ; PB ; phenobarbital ; CZP ; clonazepam ; ZNS ; zonisamide ; CLB ; clobazam ; NZP ; nitrazepam ; PRM ; primidone ; IVIG ; intravenous immunoglubulins
• 刊名：Epilepsy Research
• 出版年：November, 2013
• 年：2013
• 卷：107
• 期：1-2
• 页码：163-171
• 全文大小：1289 K

文摘

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Summary

Background

Vagus nerve stimulation (VNS) represents an adjunctive surgical option for adult and pediatric patients with drug-resistant epilepsy, who are not eligible for surgical resection or disconnection. However, little is known on its efficacy in the treatment of Epilepsia Partialis Continua (EPC), a rare but serious form of motor status epilepticus associated either with progressive or with non-evolving neurological diseases.

Purpose and methods

To evaluate the effect of VNS in a series of four children affected by medically unresponsive EPC secondary to chronic inflammatory encephalopathy (two cases), Rasmussen encephalitis (one case) and poliodystrophy (one case).

Results

After VNS implantation, the stimulation amplitude was progressively increased and, after a mean interval of 47 days, a partial reduction of EPC and associated focal seizures was observed in all patients. After a mean follow-up of three years, one child stopped EPC, two presented short and rare episodes and in one patient 2-3 residual seizures per day was reported. In all cases, reduction of epileptic activity was associated with mild improvement of motor and cognitive abilities. No serious side effects were reported.

Conclusion

VNS may be considered as an option for EPC when medical treatment fails and other more invasive neurosurgical options are not feasible.