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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Successful treatment of super-refractory non-convulsive status epilepticus with anterior thalamic deep brain stimulation

Erfolgreiche Akutbehandlungeines Falles von super-refraktärem nicht-konvulsiven Status Epileptikus mit tiefer Hirnstimulation im anterioren thalamischen Nukleus

Meeting Abstract

Suche in Medline nach

  • Lukas Imbach - UniversitätsSpital Zürich, Klinik für Neurologie, Zürich, Switzerland
  • Christian Baumann - UniversitätsSpital Zürich, Klinik für Neurologie, Zürich, Switzerland
  • Michael Weller - UniversitätsSpital Zürich, Klinik für Neurologie, Zürich, Switzerland
  • presenting/speaker Markus F. Oertel - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland
  • Lennart H. Stieglitz - UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV147

doi: 10.3205/19dgnc162, urn:nbn:de:0183-19dgnc1625

Veröffentlicht: 8. Mai 2019

© 2019 Imbach et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: We report the case of a 65-year old woman with refractory epilepsy with bilateral tonic-clonic seizures caused by progressive severe leukoencephalopathy who was treated with deep brain stimulation (DBS) for status epilepticus.

The patient was admitted to our institution under treatment with levetiracetam 3g/d, lacosamide 400mg/d valproate 2000mg/d and perampanel 6mg/d. She was initially awake and responsive but in a confusional mental state with severe neuropsychological deficits. EEG examination on admission confirmed a non-convulsive status epilepticus. Anticonvulsive treatment was extended with midazolam, phenytoin, phenobarbital and brivaracetam. Due to ongoing electrographic status epilepticus, we initiated deep burst suppression anesthesia with thiopental for 72h. EEG after thiopental coma showed persistent non-convulsive status epilepticus.

Methods: DBS electrode implantation was performed using MR-based direct targeting and stereotactic intraoperative CT in the anterior thalamic nucleus (ANT).

Stimulation was initiated intraoperatively (3V 145Hz monopolar). One day after DBS, the patient suffered from recurrent bilateral tonic-clonic seizures and electrographic ongoing status epilepticus. After adaptation of the stimulation parameters to more caudal stimulation and lower amplitude (1V 145Hz, higher contacts) the status epilepticus was finally resolved

Results: The patient showed immediate marked improvement in cognition within the next days and normalization of the neuropsychological performance to baseline level within the next 3 months.

Conclusion: This case underlines the feasibility and efficacy of anterior thalamic DBS for the treatment of super-refractory status epilepticus.