Neurosurgery Department, Fourth Medical Center, PLA General Hospital, Beijing.
Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Epileptic Disord. 2019 Aug 1;21(4):379-384. doi: 10.1684/epd.2019.1086.
We report the first patient to die from refractory convulsive status epilepticus (SE) after the removal of a stimulator. The removal occurred after a two-year period of successful control of super-refractory convulsive SE with deep brain stimulation of the bilateral anterior nucleus of the thalamus (ANT-DBS). The female patient, born in 1990, suffered from high fever and seizures, and was diagnosed with viral encephalitis in 2005. After four weeks of medical treatment, she recovered with no neurological disabilities, but suffered from monthly seizures. Ten years later, the patient presented with convulsive SE, while four months pregnant in February of 2015. Her SE remained super-refractory to drugs despite the termination of pregnancy. Therefore, ANT-DBS was performed in March of 2015. The patient became SE-free following activation of an ANT-DBS stimulator. However, the stimulation treatment was terminated according to the family's request when a tremor developed two years after the treatment had begun. Subsequently, four SE episodes occurred and the tremor did not improve. The stimulator and electrodes were removed in August of 2017. The patient died of an uncontrolled SE two months later. This case demonstrates the effectiveness of ANT-DBS for emergency super-refractory convulsive SE with both positive and negative outcomes.
我们报告了首例因移除刺激器而导致难治性惊厥性癫痫持续状态（SE）死亡的患者。该患者在双侧丘脑前核（ANT-DBS）深部脑刺激成功控制超难治性惊厥性 SE 两年后进行了移除手术。该女性患者于 1990 年出生，因高热和癫痫发作，于 2005 年被诊断为病毒性脑炎。经过四周的治疗，她康复后没有神经功能障碍，但每月仍会发作癫痫。十年后，该患者出现惊厥性 SE，同时于 2015 年 2 月怀孕四个月。尽管终止妊娠，她的 SE 仍对药物治疗无效。因此，于 2015 年 3 月进行了 ANT-DBS 治疗。ANT-DBS 刺激器激活后，患者 SE 停止发作。然而，在治疗开始两年后，当出现震颤时，根据家属的要求停止了刺激治疗。随后，又发生了四次 SE 发作，震颤并未改善。2017 年 8 月，移除了刺激器和电极。两个月后，患者死于无法控制的 SE。本病例表明，ANT-DBS 对紧急超难治性惊厥性 SE 具有积极和消极的效果。
