Vagus nerve stimulation for super-refractory status epilepticus in febrile infection–related epilepsy syndrome: a pediatric case report and literature review
Luo T, Wang Y, Lu G, Zhou Y, Wang Y.
Childs Nerv Syst. 2022 Jul;38(7):1401-1404.
https://doi.org/10.1007/s00381-021-05410-6.
Super Refractory Status Epilepticus (#SRSE) is a severe condition with limited treatment alternatives. While VNS Therapy may have a potential role in the treatment pathway of SRSE, further studies are needed to establish the efficacy of acute VNS implantation for interrupting an ongoing SE event.
This case report and scientific review by Luo et al. 2022 describe a 29-months-old patient with Febrile Infection-Related Epilepsy Syndrome (#FIRES) and SRSE that was successfully interrupted with VNS Therapy. After deeming the patient refractory to thorough pharmacological treatment, as well as non-responsive to a ketogenic diet, a VNS generator was implanted 14 days post SRSE onset. Following 42 days of rapid VNS titration, the acute phase of SRSE was successfully interrupted. No apparent adverse events were noted during the rapid titration.
While VNS was well-tolerated and appeared to successfully interrupt the ongoing SRSE, it cannot be ruled out that the SE might have ceased spontaneously, independent of VNS treatment. However, evidence from previous publications (using single-photon emission computed tomography; #SPECT) suggests that VNS may normalize the density of#GABAA receptors in the cerebral cortex, which is a probable hypothesis for the observed effect during SRSE [1]. Nevertheless, the evidence level for using VNS Therapy as a treatment for SRSE remains low and further studies are required to confirm the current result.
Ref. [1]
Marrosu F et al. 2003; Epilepsy Res. (2003) 55:59–70. doi: 10.1016/S0920-1211(03)00107-4
