Low frequency electrical stimulation through subdural electrodes in a case of refractory status epilepticus.
OBJECTIVE
We delivered low frequency stimulation through subdural electrodes to suppress seizures in a case of refractory status epilepticus (RSE).


METHODS
A 26-year-old female developed RSE after several days of febrile illness. Seizure control required continuous infusion of two anesthetics plus high doses of 2-4 enteral antiepileptic drugs. After 3 months of RSE, subdural strips were placed to determine surgical candidacy. Five independent ictal onset zones were identified. Because she was a poor candidate for epilepsy surgery and had a poor prognosis, the implanted subdural electrodes were used to administer 0.5 Hz stimulations to the ictal onset zones in 30 min trains daily for 7 consecutive days in an attempt to suppress seizures.


RESULTS
After 1 day of stimulation, one anesthetic agent was successfully discontinued. Seizures only returned by the 4th day when the second anesthetic had been reduced by 60%. Upon returning, seizures arose from only one of the 5 original ictal onset zones. Unfortunately, RSE persisted, and she eventually died.


CONCLUSIONS
In this case of RSE, low frequency stimulation through subdural electrodes transiently suppressed seizures from all but one ictal onset zone and allowed significant reduction in seizure medication.


CONCLUSIONS
Low frequency cortical stimulation may be useful in suppressing seizures.
Schrader
Lara M
LM
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room 1-194, Los Angeles, CA 90095, USA. lschrader@mednet.ucla.edu
Stern
John M
JM
Wilson
Charles L
CL
Fields
Tony A
TA
Salamon
Noriko
N
Nuwer
Marc R
MR
Vespa
Paul M
PM
Fried
Itzhak
I
D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000777:Anesthetics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods*; D004567:Electrodes, Implanted / Q000592:standards; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D049268:Positron-Emission Tomography; D003294:Seizures, Febrile / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D013226:Status Epilepticus / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D013355:Subdural Space / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D016896:Treatment Outcome
D000777:Anesthetics; D000927:Anticonvulsants