STATUS EPILEPTICUS PRECIPITATED BY TURNING OFF THE VAGUS NERVE STIMULATOR (VNS) FOR ELECTIVE BRAIN MRI
Abstract number :
3.262
Submission category :
Year :
2002
Submission ID :
3226
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Firas Beitinjaneh, Michael Guido III, Mary R. Andriola. Stony Brook Epilepsy Management Program, State University of New York, Stony Brook, NY
RATIONALE: A 40-year old female with intractable complex partial seizures with secondary generalization underwent an elective brain MRI to evaluate for possible right mesial temporal sclerosis that was suggested on a prior study. The patient was on Depakote and Zonogram. She had a VNS placed two years prior with significant improvement in her seizure control. As per the recommendations given by Cyberonics physician[ssquote]s manual regarding MRI procedure, the pulse generator output was programmed to 0 mA (from 2 mA), and the patient went directly to the MRI suite. The procedure was terminated when the patient began having tonic-clonic seizure activity. She was taken immediately to the emergency room (ER). In the ER, the patient continued to have seizures. The stimulator was turned back from 0 mA to 2 mA, but her seizures did not stop until she received a total of 4 mg of Ativan IV. Seizure control was unstable for the next 48 hours requiring admission and additional doses of Ativan. An MRI was later completed successfully with the VNS off (0 mA) after premedication with 2 mg of Ativan IV.
METHODS: We contacted the manufacturer and reviewed the literature regarding similar cases of status epilepticus after turning the VNS off for an elective MRI procedure or for any other reasons.
RESULTS: There was no reported similar complication under any circumstances.
CONCLUSIONS: Due to the risk of status epilepticus, abrupt cessation of anti-epileptic drugs (AED) is not recommended, especially in patients with intractable seizures. Such a recommendation has not been made for the VNS, although there has been concern of increased seizures when a patients[ssquote] battery wears out. This was certainly our first experience with such a dramatic increase in seizures when the stimulator was briefly disabled. After our experience with this case, we can recommend that in patients with intractable epilepsy with a well defined response to the VNS, when there is a need to turn off the device, IV access should be obtained, and a benzodiazepine should be either available or preadministered. Further similar cases need to be reported before any formal guidelines can be issued.