Refractory status epilepticus treated with trigeminal nerve stimulation.

Area of Science:

• Neurology
• Neuroscience
• Medical Devices

Background:

• Refractory status epilepticus (RSE) presents a critical challenge in neurology, demanding novel therapeutic strategies due to high morbidity and mortality.
• Existing treatments for RSE often prove insufficient, necessitating the exploration of alternative interventions for patient management.
• The need for effective treatments is underscored by cases where patients do not respond to standard antiepileptic drugs and anesthetic agents.

Observation:

• A patient with medically refractory status epilepticus (RSE) experienced persistent seizures despite aggressive treatment with multiple intravenous antiepileptic drugs and a continuous pentobarbital infusion.
• Seizures recurred upon attempts to wean the pentobarbital infusion, indicating a persistent and severe refractory state.
• External trigeminal nerve stimulation (eTNS), previously found beneficial in a clinical trial, was initiated as an alternative therapy.

Findings:

• Initiation of external trigeminal nerve stimulation (eTNS) led to the cessation of seizures in a patient with refractory status epilepticus (RSE).
• The patient's continuous pentobarbital infusion was successfully weaned four days after starting eTNS, with electroencephalogram (EEG) monitoring confirming seizure freedom.
• Post-treatment, the patient exhibited improved mental status and was discharged with moderate disability, suggesting a positive therapeutic outcome.

Implications:

• This case report suggests that external trigeminal nerve stimulation (eTNS) may possess antiseizure properties applicable to refractory status epilepticus (RSE).
• The rapid positive response observed in this patient points towards potential EEG-desynchronization as a mechanism of action for eTNS in RSE.
• Further investigation in larger clinical studies is warranted to validate eTNS as an adjunctive treatment option for refractory status epilepticus.