Parkinsonism induced by VNS in a child with double-cortex syndrome.
We describe a child with epilepsy associated with double-cortex syndrome in whom vagus nerve stimulation (VNS) generated parkinsonian symptoms. A 13-year-old girl presented with refractory secondary generalized epilepsy from the age of 6 years and mental retardation. Her electroencephalography (EEG) showed diffuse polyspike and wave discharges. Magnetic resonance imaging (MRI) showed double-cortex syndrome. She was submitted to extended callosal section at the age of 10 years, which yielded 50% seizure frequency reduction. She was submitted to VNS by the age of 12 years. As stimulation intensity was increased, there was appearance of extrapyramidal symptoms: She developed bilateral tremor and rigidity, and gait and postural disturbance. All symptoms disappeared 7-10 days after VNS was turned off. Several attempts to reactivate VNS led to the same results. During the periods when VNS was on she presented with marked seizure frequency reduction. This is the first report of a clinically evident direct effect of VNS on the basal ganglia.
Cukiert
Arthur
A
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, Brazil. acukiert@uol.com.br
Mariani
Pedro Paulo
PP
Burattini
Jose Augusto
JA
Cukiert
Cristine Mella
CM
Forster
Cassio
C
Baise
Carla
C
Argentoni-Baldochi
Meire
M
Mello
Valeria
V
D001480:Basal Ganglia Diseases / Q000209:etiology; D002648:Child; D054221:Classical Lissencephalies and Subcortical Band Heterotopias / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity; D003337:Corpus Callosum / Q000601:surgery; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D020734:Parkinsonian Disorders / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000009:adverse effects*