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Parkinsonism induced by VNS in a child with double-cortex syndrome

Arthur Cukiert1, Pedro Paulo Mariani, Jose Augusto Burattini

  • 1Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, Brazil. acukiert@uol.com.br

Epilepsia
|August 14, 2009
PubMed

Insights

Vagus nerve stimulation (VNS) effectively reduced seizures in a child with epilepsy and double-cortex syndrome. However, increasing VNS intensity triggered parkinsonian symptoms, highlighting a direct effect on the basal ganglia.

Area of Science:

  • Neurology
  • Neurophysiology

Background:

  • Epilepsy management often involves Vagus Nerve Stimulation (VNS) for refractory cases.
  • Double-cortex syndrome is a rare neuronal migration anomaly associated with intellectual disability and epilepsy.

Observation:

  • A 13-year-old female with refractory epilepsy and double-cortex syndrome underwent VNS therapy.
  • VNS therapy led to a significant reduction in seizure frequency.
  • Progressive increases in VNS intensity correlated with the emergence of parkinsonian symptoms, including tremor, rigidity, and gait disturbances.

Findings:

  • The patient experienced reversible parkinsonian symptoms directly linked to VNS intensity.
  • Discontinuation of VNS resulted in the complete resolution of extrapyramidal symptoms.
  • This case suggests a direct impact of VNS on the basal ganglia function.

Implications:

  • VNS may have previously unrecognized direct effects on basal ganglia function.
  • Careful titration of VNS is crucial in patients with underlying neurological conditions.
  • Further research is warranted to elucidate the neurobiological mechanisms underlying VNS-induced parkinsonism.

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