VNS treatment in super-refractory status epilepticus: report of two cases and systematic review of literature.

BACKGROUND

super-refractory status epilepticus (SRSE) is a rare and severe neurological condition associated with high mortality and significant long-term morbidity. In many cases, conventional medical treatments prove ineffective, with wide use of off-label therapies.

METHODS

two researchers conducted a review of the medical records of subjects who had undergone VNS implantation in our tertiary Centre. Additionally, we performed a comprehensive search of the PubMed/MEDLINE and Embase databases. Only manuscripts published in English were included in the review.

RESULTS

seventeen studies, encompassing 64 subjects (including the two patients from our series), met the inclusion criteria. The mean age at the time of VNS implantation was 17.3 years, and 52% of subjects admitted for SRSE had a prior history of epilepsy. The mean number of anti-seizure medications used before VNS implantation was 7, with a median duration of the status of 26 days prior to VNS. VNS led to the resolution of SRSE in 84% of subjects (93% of those with convulsive SRSE and 83% with non-convulsive SRSE). In terms of parameters applied, we found the following median values: Amperage: 1.75 mA; frequency: 30 Hz; Pulse Width: 500 uSec; Duty cycle: 16%; Time On: 30 sec and Time Off: 5 min.

CONCLUSION

VNS can be an effective treatment option in individuals with SRSE unresponsive to medical treatment.