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迷走神经刺激治疗成年皮质发育不良患者癫痫持续状态:一例报告

Status Epilepticus Treated With Vagus Nerve Stimulation in an Adult With Cortical Dysplasia: A Case Report.

作者信息

Gómez-Oropeza Irene, Bravo-Osorno Valeria I, Castelo-Pablos Maria F, Macías-Lopez Jonathan U, Camarena-Rubio Karen J, Pichardo-Rojas Diego, Mejía-Pérez Sonia I, Paredes-Aragón Elma

机构信息

Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, MEX.

Epilepsy Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX.

出版信息

Cureus. 2024 Dec 18;16(12):e75964. doi: 10.7759/cureus.75964. eCollection 2024 Dec.

Abstract

Status epilepticus (SE) is a neurological emergency characterized by prolonged seizures, with significant risks of neuronal injury and mortality. This case presents a 60-year-old man with drug-resistant epilepsy and a history of recurrent prolonged seizures. His seizures began in early childhood and persisted despite multiple anti-seizure medications. Notably, his semiology included the sign, suggesting an involvement of the anterior cingulate cortex and frontal lobe. Brain MRI revealed a cortical dysplasia in the right inferior frontal gyrus. Given his high risk of sudden unexpected death in epilepsy (SUDEP) due to frequent generalized tonic-clonic seizures, vagus nerve stimulation (VNS) was considered an alternative therapy, with future evaluation for a surgical intervention involving lesionectomy. Following VNS implantation, his SE was arrested with standard titration, and within six months, the patient achieved seizure freedom. This case demonstrates the use of VNS in controlling SE. Further research is necessary to determine optimal protocols for VNS use in SE.

摘要

癫痫持续状态(SE)是一种以癫痫发作持续时间延长为特征的神经急症,具有显著的神经元损伤和死亡风险。本病例为一名60岁男性,患有耐药性癫痫且有反复癫痫持续发作史。他的癫痫发作始于幼儿期,尽管使用了多种抗癫痫药物仍持续发作。值得注意的是,他的发作症状包括[此处原文缺失具体症状内容]体征,提示前扣带回皮质和额叶受累。脑部磁共振成像(MRI)显示右侧额下回皮质发育异常。鉴于他因频繁全身性强直阵挛发作而有癫痫猝死(SUDEP)的高风险,迷走神经刺激(VNS)被视为一种替代疗法,未来可评估进行包括病灶切除术在内的手术干预。植入VNS后,通过标准滴定法控制了他的癫痫持续状态,在六个月内,患者实现了无癫痫发作。本病例展示了VNS在控制癫痫持续状态中的应用。有必要进行进一步研究以确定VNS在癫痫持续状态中使用的最佳方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08a0/11741512/b27d4f296024/cureus-0016-00000075964-i01.jpg

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