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Cukiert A; Burattini JA; Mariani PP; Seda L; Forster CR; Cukiert CM; Argentoni-Baldochi M; Baise-Zung C; Mello VA.
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo SP, Brazil
Rationale: Although conventional resective and disconnective surgery is an extremely useful treatment option in patients with refractory epilepsy, 10-20% of the patients submitted to surgery would persist having seizures post-operatively. Vagus nerve (VNS) and deep brain stimulation (DBS) are treatment options in patients who failed or are not candidates for conventional surgery. There are only few patients described in the literature using both devices simultaneously.
Methods: A 32-years old lady with refractory epilepsy and daily seizures associated to unilateral right periventricular nodular heterotopia was studied. She had bilateral temporal lobe spiking with clearcut right predominance and prolongued video-EEG monitoring showed seizures coming from the right side. She was submitted to right cortico-amygdalo-hippocampectomy and extensive subependimal nodular resection four years ago. Her seizure frequency dropped to 2-3 seizures / weeks postoperatively. She was submitted two years ago to VNS and got a moderate additional seizure frequency reduction (1-2 seizures / week). She was submitted to DBS four months ago, targeted bilaterally at the ventral-anterior nucleus of the thalamus. So far, she got an additional seizure frequency reduction (2 seizures / month). Her present VNS settings are: 30sec “on”, 5 minutes “off”, 2,5mA, 30 Hz and 500usec and DBS: 1 minute “on”, 9 minutes “off” (alternating right/left), 2,25V, 100Hz, 300usec.
Results: This patient could feel when VNS electrode was on due to subtle modification of her voice. She was not able to tell when DBS was on. On the other hand, background EEG was modified whenever DBS was on. Telemetric, clinical and EEG findings showed that both devices were functioning well and without inter-device interference.
Discussion: There was no interaction between VNS and DBS devices. Apparently, patients might be submitted to both procedures without any significant inter-device interference.