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. 2023 Nov 14;13(11):1589.
doi: 10.3390/brainsci13111589.

Role of Vagus Nerve Stimulation in Refractory and Super Refractory Status Epilepticus: A Pediatric Case Series

Giulia Melinda Furlanis  1 , Jacopo Favaro  2 , Nicola Bresolin  1 , Daniele Grioni  3 , Valentina Baro  1 , Alberto D'Amico  1 , Stefano Sartori  2 , Luca Denaro  1 , Andrea Landi  1
Affiliations

Role of Vagus Nerve Stimulation in Refractory and Super Refractory Status Epilepticus: A Pediatric Case Series

Giulia Melinda Furlanis et al. Brain Sci. .

Abstract

Background: Status epilepticus is a life-threatening condition that is defined as refractory (RSE) when the seizure activity continues despite treatment with benzodiazepine and a second appropriate treatment. Super refractory status epilepticus (SRSE) is an RSE that persists or recurs for ≥24 h. Few papers have reported the outcomes of pediatric patients affected by RSE and SRSE and treated with neuromodulation therapies. Vagus nerve stimulation (VNS) is an approved treatment for drug-resistant epilepsy. We present our findings of pediatric patients treated with VNS for RSE/SRSE.

Methods: We present a case series of seven consecutive pediatric patients treated with VNS for SRSE since 2012 by a single surgeon in Monza and Padua. A rapid titration was started soon after implantation. We considered electroclinical data before and after VNS implantation and at the last follow-up.

Results: We achieved the resolution of SRSE in five out of seven patients in a mean time of two weeks. At the last follow-up, these patients had a significant reduction of seizure burden without any relapse of SE.

Discussion and conclusions: Based on our limited findings, we discuss the potential role of VNS therapy in similar but distinct clinical contexts. For patients with drug-resistant epilepsy and RSE/SRSE, prompt VNS consideration is suggested, offering rapid responses and potentially reducing pharmacological load. Meanwhile, in NORSE/FIRES, we suggest early neuromodulation during the acute phase if standard treatments prove ineffective or not tolerated. This approach may leverage VNS's potential anti-inflammatory effects and neuromodulation, enhancing patient-specific treatments. Expanding case studies and prolonged follow-ups are recommended to strengthen these clinical insights.

Keywords: FIRES; NORSE; neuromodulation; pediatric epilepsy; super refractory status epilepticus; vagus nerve stimulation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Two samples of electroencephalographic evolution following VNS implantation. Panels (A,C) demonstrate in two different subjects the persistence of status epilepticus despite the sequential treatment with anti-seizure medications, anesthetics, and immunomodulant therapies. Panels (B,D) display the interictal EEG of the same patients 2 months after VNS implantation.
Figure 1
Figure 1
Two samples of electroencephalographic evolution following VNS implantation. Panels (A,C) demonstrate in two different subjects the persistence of status epilepticus despite the sequential treatment with anti-seizure medications, anesthetics, and immunomodulant therapies. Panels (B,D) display the interictal EEG of the same patients 2 months after VNS implantation.
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