Low Frequency Centromedian Thalamic Nuclei Deep Brain Stimulation for the treatment of Super Refractory Status Epilepticus: A Case Report and a review of the literature
Abstract
https://doi.org/10.1016/j.brs.2020.12.013 1935-861X/© 2020 The Author(s). Published by Elsevie ). Super refractory status epilepticus (srSE) refers to a SE that fails to respond to 1st and 2nd line treatments and persists after 24 hours of anaesthesia carrying increased risk of mortality, morbidity, and disability. Centromedian Thalamic Nucleus DBS (CMN DBS) appears to provide some benefit in refractory generalised epilepsy [1,2], but its efficacy and the best stimulation parameters for this condition remain unclear. We report the case of a 15-year-old right-handed girl with normal development and no family history of epilepsy. Bilateral tonic-clonic seizures (BTCS) started at the age of 5 leading to srSE with Paediatric Intensive Care Unit (PICU) admission and thiopentone coma induction. The possibility of hemophagocytic lymphohistiocytosis/macrophage activation syndrome (MAS) was raised and she was discharged 4 weeks later on levetiracetam, steroids and cyclosporine with cognitive, language and behavioural difficulties. She developed brief asymmetric tonic seizures with occasional clusters of 20e30 seizures/day. Multiple AEDs (phenytoin, levetiracetam, carbamazepine, lacosamide, lamotrigine, perampanel, zonisamide, stiripentol) and ketogenic diet provided limited benefit. A second srSE occurred aged 9 with a 6-week PICU admission and further regression in cognition. Following discharge, she had significant sleep issues and clusters of daytime focal seizures and…
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