Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Epilepsy Res. 2014 Mar;108(3):600-3. doi: 10.1016/j.eplepsyres.2013.12.010. Epub 2013 Dec 30.
Refractory status epilepticus (RSE) is a neurologic emergency associated with significant morbidity and mortality. Alternative therapies are needed for patients who do not respond to more traditional therapies for RSE. We report on a patient with RSE treated with external trigeminal nerve stimulation (eTNS). On admission, the patient was experiencing consecutive focal dyscognitive seizures with secondary generalization without recovery in between. His seizures remained refractory to multiple therapies, including IV lorazepam, valproic acid, levetiracetam, phenobarbital, and midazolam. Although a burst suppression pattern was achieved with a continuous pentobarbital infusion, seizures returned following attempts to taper it. Given his beneficial response to eTNS during a previous clinical trial, eTNS was initiated. Four days after starting eTNS, the pentobarbital infusion was finally weaned, and his EEG revealed no further seizures. The patient's mental status improved and he was ultimately discharged with only moderately severe disability. Our case demonstrates that eTNS may have antiseizure effects in RSE. Given our patient's quick response, such benefit may have arisen from EEG-desynchronization. If confirmed in larger studies, eTNS could one day be considered along with other adjuvant treatments for RSE.
难治性癫痫持续状态（RSE）是一种与高发病率和死亡率相关的神经急症。对于那些对传统的 RSE 治疗方法没有反应的患者，需要替代疗法。我们报告了一例使用外部三叉神经刺激（eTNS）治疗的 RSE 患者。入院时，患者连续出现局灶性认知障碍性癫痫发作，继发全面性发作，发作之间无恢复。他的癫痫发作对多种治疗方法仍无反应，包括静脉注射劳拉西泮、丙戊酸、左乙拉西坦、苯巴比妥和咪达唑仑。尽管持续输注戊巴比妥可达到爆发抑制模式，但在试图减少剂量后，癫痫发作又再次出现。鉴于他之前的临床试验中对 eTNS 有良好的反应，因此开始使用 eTNS。在开始使用 eTNS 的四天后，戊巴比妥输注终于被逐渐减少，他的脑电图显示没有进一步的癫痫发作。患者的精神状态有所改善，最终出院时仅有中度严重残疾。我们的病例表明，eTNS 可能对 RSE 具有抗癫痫作用。鉴于我们患者的快速反应，这种益处可能源于脑电图去同步化。如果在更大规模的研究中得到证实，eTNS 可能有一天会与 RSE 的其他辅助治疗方法一起被考虑。
