scholarly journals Vagus Nerve Stimulation (VNS) in Super Refractory New Onset Refractory Status Epilepticus (NORSE)

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Mohankumar Kurukumbi ◽  
James Leiphart ◽  
Anam Asif ◽  
Jing Wang

The treatment protocol of status epilepticus has many associated toxicities so there is interest in alternate nonmedicinal therapies for managing New Onset Refractory Status Epilepticus (NORSE) patients. Vagus nerve stimulation (VNS) is an FDA-approved therapy for refractory epilepsy that has been shown to decrease the frequency and severity of seizures. We present the case of a patient with new-onset refractory status epilepticus (NORSE) whose seizures were successfully treated with vagus nerve stimulation. A 25-year-old male with no history of epilepsy or other neurological disorders presented with altered mental status and generalized tonic-clonic seizures following a two-week history of an upper respiratory tract infection. Lumbar puncture showed neutrophilic pleocytosis, and he was treated for bacterial and viral meningoencephalitis. In spite of treatment, his seizures began increasing in frequency. On day three, the patient entered status epilepticus (SE) refractory to intensive pharmacotherapy with maximal doses of valproate, levetiracetam, and propofol. On day four, SE remained refractory, so pentobarbital was introduced with targeted burst suppression pattern on electroencephalography (EEG). Patient continued to be refractory to these measures, so a vagus nerve stimulator (VNS) was implanted (day eight). Following VNS implantation, EEG demonstrated significant reduction of seizure activity and subsequent magnet swiping continued aborting electrographic seizures. No SE or electrographic seizures were reported for seventy-two hours, but few occasional discharges were reported. Seizures eventually recurred on day fourteen and the patient succumbed to his multiple comorbidities on day seventeen. Due to the efficacy of VNS in refractory epilepsy, there was interest in using it in refractory status epilepticus. Multiple case reports have described a benefit from implantation of VNS in the treatment of SE. The successful use of VNS to acutely terminate status epilepticus for seventy-two hours in this critically ill patient adds to current evidence that there is utility in using VNS for refractory status epilepticus.

Seizure ◽  
2017 ◽  
Vol 47 ◽  
pp. 1-4 ◽  
Author(s):  
Tomohiro Yamazoe ◽  
Tohru Okanishi ◽  
Atsushi Yamamoto ◽  
Takehiro Yamada ◽  
Mitsuyo Nishimura ◽  
...  

2019 ◽  
Vol 12 (5) ◽  
pp. 1101-1110 ◽  
Author(s):  
Maxine Dibué-Adjei ◽  
Francesco Brigo ◽  
Takamichi Yamamoto ◽  
Kristl Vonck ◽  
Eugen Trinka

2009 ◽  
Vol 13 (3) ◽  
pp. 286-289 ◽  
Author(s):  
Veerle De Herdt ◽  
Liesbeth Waterschoot ◽  
Kristl Vonck ◽  
Bart Dermaut ◽  
Helene Verhelst ◽  
...  

2019 ◽  
Vol 12 (6) ◽  
pp. 1605-1607 ◽  
Author(s):  
B. Mostacci ◽  
F. Bisulli ◽  
L. Muccioli ◽  
I. Minardi ◽  
M. Bandini ◽  
...  

2019 ◽  
Vol 101 ◽  
pp. 106807
Author(s):  
Francesca Bisulli ◽  
Barbara Mostacci ◽  
Lorenzo Muccioli ◽  
Irene Minardi ◽  
Marco Bandini ◽  
...  

2020 ◽  
Vol 11 ◽  
Author(s):  
Nicola Specchio ◽  
Alessandro Ferretti ◽  
Nicola Pietrafusa ◽  
Marina Trivisano ◽  
Costanza Calabrese ◽  
...  

2009 ◽  
Vol 27 (3) ◽  
pp. E5 ◽  
Author(s):  
Dzenan Lulic ◽  
Amir Ahmadian ◽  
Ali A. Baaj ◽  
Selim R. Benbadis ◽  
Fernando L. Vale

Vagus nerve stimulation (VNS) is a key tool in the treatment of patients with medically refractory epilepsy. Although the mechanism of action of VNS remains poorly understood, this modality is now the most widely used nonpharmacological treatment for drug-resistant epilepsy. The goal of this work is to review the history of VNS and provide information on recent advances and applications of this technology.


2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shahan Waheed ◽  
Amber Sabeen ◽  
Nadeem Ullah Khan

New onset refractory status epilepticus (NORSE) is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures.


2018 ◽  
Vol 11 (1) ◽  
pp. 80-85
Author(s):  
Rodrigo Marmo da Costa e Souza ◽  
Felipe Ricardo Pereira Vasconcelos De Arruda ◽  
Jose Anderson Galdino Santos ◽  
Jamerson De Carvalho Andrade ◽  
Suellen Mary Marinho Dos Santos Andrade ◽  
...  

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