Vagus nerve stimulation in a case of epilepsy with CSWSS: respiratory side effects during sleep

Autor: Fabrice Wallois, Patrick Berquin, Nicole Larnicol, Claire Heberlé
Přispěvatelé: Centre de recherche en neurobiologie - neurophysiologie de Marseille (CRN2M), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Dumonceaud, Corinne
Jazyk: angličtina
Rok vydání: 2002
Předmět:
Hypersalivation
MESH: Combined Modality Therapy
medicine.medical_treatment
Stimulation
MESH: Respiratory Function Tests
Benzodiazepines
Epilepsy
0302 clinical medicine
MESH: Vagus Nerve
MESH: Child
030212 general & internal medicine
Child
[SDV.BBM.BC] Life Sciences [q-bio]/Biochemistry
Molecular Biology/Biochemistry [q-bio.BM]
MESH: Sleep Disorders
Neck pain
Age Factors
Gestational age
Vagus Nerve
Combined Modality Therapy
Respiratory Function Tests
3. Good health
Neurology
MESH: Respiration Disorders
Anesthesia
MESH: Epilepsy
Anticonvulsants
Female
medicine.symptom
Vagus nerve stimulation
Sleep Wake Disorders
Phenylcarbamates
MESH: Electric Stimulation Therapy
Electric Stimulation Therapy
03 medical and health sciences
MESH: Anticonvulsants
MESH: Phenylcarbamates
medicine
Humans
[SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry
Molecular Biology/Biochemistry [q-bio.BM]
MESH: Propylene Glycols
MESH: Age Factors
Pregnancy
MESH: Humans
business.industry
Respiration Disorders
medicine.disease
Felbamate
MESH: Anti-Anxiety Agents
MESH: Epilepsies
Partial
Anti-Anxiety Agents
Propylene Glycols
MESH: Benzodiazepines
Clobazam
Epilepsies
Partial
Neurology (clinical)
business
MESH: Female
030217 neurology & neurosurgery
Ketogenic diet
Zdroj: Epilepsia
Epilepsia, Wiley, 2002, 43 (10), pp.1268-70
Epilepsia, 2002, 43 (10), pp.1268-70
ISSN: 0013-9580
Popis: We would like to alert the medical community to pos-sible respiratory side effects of vagal nerve stimulation(VNS) during the treatment of nonsurgical refractorypartial epilepsy. We observed hypopneic–polypneic epi-sodes during sleep in a 9-year-old girl with epilepsy withcontinuous spike–waves during slow sleep (CSWSS)syndrome. These events were time-locked to each periodof VNS stimulation and occurred without any modifica-tion of cardiac frequency. VNS may elicit a reduction of25–50% in seizure frequency in both adults and childrenwith intractable epilepsy (1). Adverse side effects andcomplications of VNS were few and mostly transient andwere reported in adult patients only. They includehoarseness, neck pain, hypersalivation, cough, and short-ness of breath (“air-missing”) sensations during physicalexercise. These sensations might be related to the in-crease in end-expiratory volume observed in some pa-tients receiving stimulation at high intensity. In contrastto the common observation that VNS modifies the respi-ratory pattern in animals, only one study has reportedalterations in the respiratory pattern in humans (2).In the present case, the mother’s pregnancy wasmarked by fetal death of a twin sister at 24 weeks ofpostconceptional age. Birth was uneventful at 36 weeksof gestational age. Systematic transfontanellar ultrasoundanalysis revealed bilateral diffuse periventricular leuko-malacia. At age 2 years, she had right tonic partial sei-zures with loss of contact, and magnetic resonanceimaging (MRI) evidenced a left parietal extended isch-emic lesion.At age 5 years, her seizures changed and increased infrequency: during daytime, they were characterized byabsence seizures associated with mild and inconstant ato-nia (up to one seizure every 2–3 min). Sleep EEGshowed CSWSS. Over the course of the following year,she was treated unsuccessfully with seven different an-tiepileptic drugs (AEDs). A ketogenic diet also was in-effective. She was considered an ineligible candidate forsurgery because of the extent of the left sylvian ischemiclesion.At age 6 years, a neurocybernetic prosthesis (Cyberon-ics, Houston, Texas U.S.A.) was implanted. The stimu-lation allowed a drug-free period of 2 months, duringwhich there was an initial seizure-free period of 6 weeks.Then absences reappeared but were less numerous thanbefore implantation. Subsequently she was given la-motrigine (LTG) with VNS. Despite the use of variousAED combinations and changes in stimulation param-eters over the next year, the absences persisted.At age 6
Databáze: OpenAIRE
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