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Immediate Postoperative Activation of Vagus Nerve Stimulation (VNS) for Super-refractory Status Epilepticus: A Case
Karen J Camarena-Rubio1, Brandon Flores-Patiño1, Jonathan U Macías López1
1Epilepsy Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
Abstract:
Anti-NMDA (N-methyl-D-aspartate) receptor encephalitis (ANRE) is a rare autoimmune condition targeting brain receptors, often linked to ovarian tumors in young women. In severe cases, it can lead to status epilepticus, but in sporadic cases, it may progress to super-refractory status epilepticus (SRSE), a dangerous state of continuous or repetitive seizures demanding urgent medical attention that continues or recurs more than 24 hours after the initiation of anesthetic therapy. We present a case report of anti-NMDA receptor limbic encephalitis-triggered SRSE terminated with vagus nerve stimulation (VNS) and titrated to high stimulation parameters in the immediate postoperative period. Titrating VNS to high stimulation parameters immediately postoperatively under specialized neuroanesthesia is a safe and effective treatment for nonconvulsive SRSE in anti-NMDA receptor limbic encephalitis. However, further research is needed to solidify this approach as a standard treatment option in these circumstances since the SRSE is rare. Expanding the evidence base will help improve patient outcomes and reduce morbidity and mortality associated with this condition.
Insights
Anti-NMDA receptor encephalitis can trigger super-refractory status epilepticus. Vagus nerve stimulation (VNS) at high parameters effectively terminated this condition in a case report, suggesting a potential new treatment.
Area of Science:
- Neurology
- Immunology
- Oncology
Background:
- Anti-NMDA receptor encephalitis (ANRE) is a rare autoimmune disorder.
- ANRE can lead to severe neurological complications like status epilepticus (SE).
- Super-refractory status epilepticus (SRSE) is a life-threatening progression of SE.
Observation:
- A case of ANRE-triggered SRSE in a young woman is presented.
- The SRSE persisted despite anesthetic therapy.
- Vagus nerve stimulation (VNS) was initiated in the immediate postoperative period.
Findings:
- VNS was titrated to high stimulation parameters under specialized neuroanesthesia.
- This high-parameter VNS successfully terminated the nonconvulsive SRSE.
- The treatment was deemed safe and effective in this specific case.
Implications:
- High-parameter VNS may be a viable treatment for SRSE in ANRE.
- Further research is needed to establish VNS as a standard treatment.
- Improved outcomes and reduced mortality are potential benefits for patients with ANRE-associated SRSE.
