Low frequency electrical stimulation through subdural electrodes in a case of refractory status epilepticus

We delivered low frequency stimulation through subdural electrodes to suppress seizures in a case of refractory status epilepticus (RSE). A 26-year-old female developed RSE after several days of febrile illness. Seizure control required continuous infusion of two anesthetics plus high doses of 2–4 e...

Full description

Saved in:
Bibliographic Details
Published in:Clinical neurophysiology 2006-04, Vol.117 (4), p.781-788
Main Authors: Schrader, Lara M., Stern, John M., Wilson, Charles L., Fields, Tony A., Salamon, Noriko, Nuwer, Marc R., Vespa, Paul M., Fried, Itzhak
Format: Article
Language:English
Subjects:
Action Potentials - physiology
Adult
Anesthetics - therapeutic use
Anesthetics. Neuromuscular blocking agents
Anticonvulsants - therapeutic use
Biological and medical sciences
Cerebral Cortex - anatomy & histology
Cerebral Cortex - diagnostic imaging
Cerebral Cortex - surgery
Cortical stimulation
Dura Mater - anatomy & histology
Dura Mater - surgery
Electric Stimulation Therapy - instrumentation
Electric Stimulation Therapy - methods
Electrical stimulation
Electrodes, Implanted - standards
Female
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Low frequency repetitive stimulation
Magnetic Resonance Imaging
Medical sciences
Nervous system (semeiology, syndromes)
Neurology
Neuropharmacology
Pharmacology. Drug treatments
Positron-Emission Tomography
Refractory status epilepticus
Seizures
Seizures, Febrile - diagnostic imaging
Seizures, Febrile - physiopathology
Seizures, Febrile - therapy
Status Epilepticus - diagnostic imaging
Status Epilepticus - physiopathology
Status Epilepticus - therapy
Subdural Space - anatomy & histology
Subdural Space - physiology
Subdural Space - surgery
Treatment
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We delivered low frequency stimulation through subdural electrodes to suppress seizures in a case of refractory status epilepticus (RSE). A 26-year-old female developed RSE after several days of febrile illness. Seizure control required continuous infusion of two anesthetics plus high doses of 2–4 enteral antiepileptic drugs. After 3 months of RSE, subdural strips were placed to determine surgical candidacy. Five independent ictal onset zones were identified. Because she was a poor candidate for epilepsy surgery and had a poor prognosis, the implanted subdural electrodes were used to administer 0.5 Hz stimulations to the ictal onset zones in 30 min trains daily for 7 consecutive days in an attempt to suppress seizures. After 1 day of stimulation, one anesthetic agent was successfully discontinued. Seizures only returned by the 4th day when the second anesthetic had been reduced by 60%. Upon returning, seizures arose from only one of the 5 original ictal onset zones. Unfortunately, RSE persisted, and she eventually died. In this case of RSE, low frequency stimulation through subdural electrodes transiently suppressed seizures from all but one ictal onset zone and allowed significant reduction in seizure medication. Low frequency cortical stimulation may be useful in suppressing seizures.
ISSN:1388-2457
1872-8952
DOI:10.1016/j.clinph.2005.12.010