Control of refractory status epilepticus precipitated by anticonvulsant withdrawal using left vagal nerve stimulation: a case report

Patwardhan, Ravish V.; DellaBadia, John; Rashidi, Mahmoud; Grier, Laurie; Nanda, Anil

doi:10.1016/j.surneu.2004.11.026

Cited by 64 publications

(34 citation statements)

References 18 publications

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“…Multiple case series subsequently documented the role of surgical intervention for RSE. 1,3,4,[9][10][11][12]16,17,19,20,22,24,27 Interventions included focal cortical resection, hemispherectomy, MST, vagus nerve stimulation, and callosotomy. Ng et al 20 described 5 patients with RSE successfully treated with neurosurgical intervention: 3 who underwent focal cortical resection and 1 each who underwent hemispherectomy and transcallosal resection of a hypothalamic hamartoma.…”

Section: Van Nessmentioning

confidence: 99%

“…The literature also included 2 patients with RSE successfully treated with acute vagus nerve stimulator placement. 24,36 Prolonged SE and the effects of HDST can make delineation of the epileptogenic region more challenging. A discrete or lateralized abnormality on MRI provides the easiest and perhaps most reliable means of defining a resectable region during the acute phase.…”

Section: 2021mentioning

confidence: 99%

“…Studies on the surgical treatment of RSE are therefore limited to single case reports or small series involving cortical resection, callosal sectioning, multiple subpial transections (MSTs), hemispherectomy, and vagus nerve stimulation. 1,3,4,[9][10][11][12]16,17,19,20,24 There is no consensus on how or when to surgically manage this medical emergency. Object.…”

mentioning

confidence: 99%

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Surgical treatment of refractory status epilepticus in children

Bhatia

Ahmad²,

Miller

et al. 2013

PED

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Object Refractory status epilepticus (RSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Affected patients often require prolonged intensive care and can suffer multiple complications. Surgical intervention to control RSE is rarely used but can obviate the risks of prolonged seizures and intensive care treatment. Authors of the present study analyzed their experience with the surgical management of patients suffering from RSE. Methods The Epilepsy Surgery Database at Miami Children's Hospital was reviewed for patients who had undergone surgery for RSE. Clinical presentation, electrophysiological profile, radiological data, surgical details, and postoperative course were evaluated. Results Between 1990 and 2012, 15 patients underwent surgery for uncontrolled seizures despite high-dose medical suppressive therapy. The mean preoperative duration of status epilepticus was 8 weeks. Ictal SPECT and FDG-PET imaging in conjunction with intraoperative electrophysiological studies helped to outline the extent of resection. Surgical intervention controlled seizures in all patients and facilitated the transition out of intensive care. Adverse events related to a prolonged intensive care unit stay included sepsis and respiratory complications. Four patients had worsened neurological function, developing hemiparesis and dysphasia. There was no operative mortality. Conclusions Surgical intervention can successfully control refractory partial status epilepticus, prevent associated morbidity, and decrease intensive care unit stay. Ictal SPECT and PET are valuable in guiding resection.

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Section: Van Nessmentioning

confidence: 99%

Section: 2021mentioning

confidence: 99%

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Surgical treatment of refractory status epilepticus in children

Bhatia

Ahmad²,

Miller

et al. 2013

PED

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“…Winston et al 43 described the case of a 13-year-old boy in whom VNS interrupted a convulsive SE immediately after stimulation was started. Patwardan et al 44 described the case of a 30-year-old man with medically intractable seizures due to severe allergic reactions to multiple antiepileptic drugs (AEDs), with subsequent evolution into refractory SE. He underwent VNS treatment after nearly 9 days of barbiturate-induced coma.…”

mentioning

confidence: 99%

“…The patient became seizure-free. 44 Zimmerman et al 45 described the cases of three adult patients in whom refractory nonconvulsive SE due to AED withdrawal was treated with VNS. After implantation of the device, stimulation output was rapidly increased to 3 mA; time to termination of the SE was 3 to 5 days.…”

mentioning

confidence: 99%

Electrical Stimulation for the Treatment of Epilepsy

et al. 2009

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Summary: Despite the advent of new pharmacological treatments and the high success rate of many surgical treatments for epilepsy, a substantial number of patients either do not become seizure-free or they experience major adverse events (or both). Neurostimulation-based treatments have gained considerable interest in the last decade. Vagus nerve stimulation (VNS) is an alternative treatment for patients with medically refractory epilepsy, who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. Although responder identification studies are lacking, long-term VNS studies show response rates between 40% and 50% and long-term seizure freedom in 5% to 10% of patients. Surgical complications and perioperative morbidity are low. Research into the mechanism of action of VNS has revealed a crucial role for the thalamus and cortical areas that are important in the epileptogenic process. Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies. There is little evidence-based information on rational targets and stimulation parameters. Amygdalohippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Data from pilot studies suggest that chronic DBS for epilepsy may be a feasible, effective, and safe procedure. Further trials with larger patient populations and with controlled, randomized, and closed-loop designs should now be initiated. Further progress in understanding the mechanism of action of DBS for epilepsy is a necessary step to making this therapy more efficacious and established.

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