Vagus nerve stimulation for drug-resistant Epilepsia Partialis Continua: report of four cases.
BACKGROUND
Vagus nerve stimulation (VNS) represents an adjunctive surgical option for adult and pediatric patients with drug-resistant epilepsy, who are not eligible for surgical resection or disconnection. However, little is known on its efficacy in the treatment of Epilepsia Partialis Continua (EPC), a rare but serious form of motor status epilepticus associated either with progressive or with non-evolving neurological diseases.


OBJECTIVE
To evaluate the effect of VNS in a series of four children affected by medically unresponsive EPC secondary to chronic inflammatory encephalopathy (two cases), Rasmussen encephalitis (one case) and poliodystrophy (one case).


RESULTS
After VNS implantation, the stimulation amplitude was progressively increased and, after a mean interval of 47 days, a partial reduction of EPC and associated focal seizures was observed in all patients. After a mean follow-up of three years, one child stopped EPC, two presented short and rare episodes and in one patient 2-3 residual seizures per day was reported. In all cases, reduction of epileptic activity was associated with mild improvement of motor and cognitive abilities. No serious side effects were reported.


CONCLUSIONS
VNS may be considered as an option for EPC when medical treatment fails and other more invasive neurosurgical options are not feasible.
Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS. 4, Piazza Sant'Onofrio, 00165 Roma, Italy. Electronic address: alessandro.debenedictis@opbg.net.
Alessandro
A
De Benedictis
Elena
E
Freri
Michele
M
Rizzi
Angelo
A
Franzini
Francesca
F
Ragona
Nicola
N
Specchio
Erika
E
Rebessi
Marina
M
Casazza
Tiziana
T
Granata
Carlo Efisio
CE
Marras
D000293:Adolescent; D002648:Child; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000150:complications; D004660:Encephalitis / Q000150:complications; D017036:Epilepsia Partialis Continua / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D019233:Retreatment; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*; D055815:Young Adult
ACDs; CBZ; CLB; CZP; Drug-resistant epilepsy; EPC; Epilepsia Partialis Continua; IVIG; LVT; MDZ; NZP; OXC; PB; PHT; PRM; RE; Rasmussen's encephalitis; SE; TPM; VNS; VPA; Vagus nerve stimulation; ZNS; anticonvulsant drugs; carbamazepine; clobazam; clonazepam; intravenous immunoglubulins; leviracetam; midazolam; nitrazepam; oxcarbamazepine; phenitoyne; phenobarbital; primidone; status epilepticus; topiramate; vagus nerve stimulation; valproic acid; zonisamide