Article
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
Search Medline for
Authors
Published: | May 8, 2019 |
---|
Outline
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.