title: Vagus Nerve Stimulation for Electrographic Status Epilepticus in Slow-Wave Sleep.
abstract: Electrographic status epilepticus in slow sleep or continuous spike and waves during slow-wave sleep is an epileptic encephalopathy characterized by seizures, neurocognitive regression, and significant activation of epileptiform discharges during nonrapid eye movement sleep. There is no consensus on the diagnostic criteria and evidence-based optimal treatment algorithm for children with electrographic status epilepticus in slow sleep.
  
  
  
  We describe a 12-year-old girl with drug-resistant electrographic status epilepticus in slow wave sleep that was successfully treated with vagus nerve stimulation. Her clinical presentation, presurgical evaluation, decision-making, and course after vagus nerve stimulator implantation are described in detail.
  
  
  
  After vagus nerve stimulator implantation, the girl remained seizure free for more than a year, resolved the electrographic status epilepticus in slow sleep pattern on electroencephalography, and exhibited significant cognitive improvement.
  
  
  
  Vagus nerve stimulation may be considered for electrographic status epilepticus in slow sleep.
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Carosella
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Hansel M
authors.initials: HM
authors.lastname: Greiner
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Anna W
authors.initials: AW
authors.lastname: Byars
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Arthur
authors.affiliation: Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: James L
authors.initials: JL
authors.lastname: Leach
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Michele
authors.initials: M
authors.lastname: Turner
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Holland
authors.affiliation: Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Ravindra.Arya@cchmc.org.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Arya
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D002648:Child; D004569:Electroencephalography; D005260:Female; D006801:Humans; D012890:Sleep / Q000502:physiology*; D013226:Status Epilepticus / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D055536:Vagus Nerve Stimulation
keywords: continuous spike and waves during slow-wave sleep (CSWS); electrographic status epilepticus in slow sleep; epilepsy surgery; vagus nerve stimulation (VNS)