Does emergent implantation of a vagal nerve stimulator stop refractory status epilepticus in children?. (October 2018)

• Record Type: Journal Article
• Authors: Grioni, Daniele; Landi, Andrea; Fiori, Leonardo; Sganzerla, Erik Pietro
• Is Part Of: Seizure. Volume 61(2018)
• Page Start: 94
• Page End: 97
• Publication Date: 2018-10
• Subjects: Status epilepticus -- Childhood -- Vagal nerve stimulation; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2018.08.008
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Status Epilepticus (SE) can be a serious life threatening event. Vagal Nerve Stimulation (VNS) has proved efficacy in treating severe epilepsies. The Authors reported the results in treating 4 cases of SE with VNS. In 3 out of 4 cases the SE stopped. VNS could be a option in medical practice, although more clinical evidence is needed. Abstract: Purpose: Status Epilepticus can be a serious life threatening event in epileptic patients. The definition of refractory or super-refractory Status Epilepticus was based on the therapeutic response to anti-epileptic and anesthetic drugs. Vagal Nerve Stimulation showed efficacy in treating drug-resistant epilepsy but there are only few reports on emergentplacement of Vagal Nerve Stimulator for refractory or super-refractory Status Epilepticus. Methods: Among 49 children implanted at our Institution with Vagal Nerve Stimulation for drug-resistant epilepsy, the authors retrospectively identified those implanted for refractory or super-refractory Status Epilepticus, according with the current definitions. Results: 4 patients were operated upon at ages ranging 7 to 17 months and reached the programmed output current of 1 mA over a time ranging from 24 to 36 h (fast ramping-up). In 3 out of 4 patient we observed the abrupt of Status Epilepticus; one patient was refractory both to drugs and Vagal Nerve Stimulation and later died, without recovering from SE. At follow up, ranging from 24 to 45 months, the remaining 3 patients showed a decrease of the seizures frequency >80% without relapse of Status Epilepticus; in all the patients, output current and/or Duty Cycle were increased later. Conclusion: VNS can be effective in treating refractory or super-refractory Status Epilepticus.