Introduction. Periventricular nodular heterotopia (PNH) is a malformation of
cortical development which is characterized by abnormal migration of neurons
to the cortical plate and is very often linked to drug -resistant focal
epilepsy. Case report. A 33-year-old woman with a severe drug-resistant
epilepsy is presented. She suffered from focal epilepsy predominantly
characterized by focal seizures and occasionally focal to bilateral
tonic-clonic seizures. Magnetic resonance imaging showed bilateral
heterotopic nodules in the occipital horns of the lateral ventricles.
18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) scan
demonstrated a zone of reduced glucose metabolism on the right temporal
region. Electroencephalogram suggested focal electrocortical activity on the
temporo-parieto-occipital regions, predominantly on the temporal right. The
woman was treated with polytherapy (valproic acid, lamotrigine,
levetiracetam, oxcarbazepine, pregabalin, clobazam, lacosamide) but it did
not affect the seizure frequency. Surgical treatment was not recommended due
to bilateral localization of the heterotopic nodules. We decided on vagus
nerve stimulation (VNS) and achieved satisfying seizure control. Conclusion.
Patients with PNH require multidisciplinary assessment and treatment, while
this report represents a case of a patient with satisfying seizure control
after the VNS implantation.