Vagus Nerve Stimulation Use in Refractory Status Epilepticus
Abstract number :
3.47
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
476
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jessica Bloomfield, MD – Cambridge Health Alliance
Anirudha Rathnam, MD – Icahn School of Medicine at Mount Sinai
Fedor Panov, MD – Mount Sinai Health System
Saadi Ghatan, MD – Mount Sinai Health System
Leah Blank, MD – Icahn School of Medicine at Mount Sinai
Lara Marcuse, MD – Icahn School of Medicine at Mount Sinai
Madeline Fields, MD – Icahn School of Medicine at Mount Sinai
Anuradha Singh, MD – Icahn School of Medicine at Mount Sinai
Maite Lavega-Talbott, MD – Icahn School of Medicine at Mount Sinai
Noah Nichols, MD – Icahn School of Medicine at Mount Sinai
Onome Eka, MBBS – Icahn School of Medicine at Mount Sinai, New York City
Dina Bolden, NP – Mount Sinai Hospital
Neha Dangayach, MD – Icahn School of Medicine at Mount Sinai
Jiyeoun (Jenna) Yoo, MD – Icahn School of Medicine at Mount Sinai
Rationale: Resistance to anti-seizure medication is a major challenge in the treatment of Refractory Status Epilepticus (RSE) and especially in new onset refractory status epilepticus (NORSE) which often presents with Super Refractory Status Epilepticus (SRSE). VNS neuromodulation is an important adjunct to medical management in drug-resistant epilepsy and recently has shown promise for use in RSE. We present a case series with RSE at a tertiary academic medical center who received VNS in addition to maximal medical management.
Methods: Patients who received VNS in the acute setting were identified from the Mount Sinai Health System’s epilepsy surgery database from 2018-2024. Electronic medical records were reviewed for demographic data, EEG findings, VNS settings, and patient outcomes (modified Rankin Score; mRS).
Results: Patients ranged in age from 16-77 years old. Eight of these patients (50%) had NORSE, 8 had a prior history of epilepsy, and all but 2 patients had SRSE. The average time from the time of RSE to VNS implant was 20.06 days (range 2-67 days). All patients were discharged to rehabilitation except for one patient who died secondary to multiple cardiac arrests in the setting of continued electrographic SE, fungemia, and respiratory failure, thought to be unrelated to VNS implant. Outcome on discharge ranged from mRS of 2-5 with a mean score of 4. Of note, patients with the NORSE had a mean mRS of 3.5 compared to a mean score of 4 for those with a prior epilepsy diagnosis. All 15 surviving patients remained out of electrographic SE post VNS placement with output currents as low as 0.25mA. There were no reported VNS related complications in all 16 patients. In all but 3 patients initial VNS output current was 0.25mA. Titration schedules varied with final settings ranging from 0.25mA to 2.25mA on discharge (Table 1).
Conclusions: We report a case series of 16 patients with RSE who underwent VNS placement as an adjunct to medical management of their status epilepticus. All surviving patients remained out of electrographic SE post VNS, and none of the patients had VNS associated complications. Escalation of medical management with anesthetic medications carries multiple risks including hypotension, respiratory depression and ileus. This case series suggests that VNS should be considered as a safe addition to the established management of RSE. Further work is needed to determine the ideal timing, dose and titration schedule for VNS placement after diagnosis of RSE as well as the long-term outcomes associated with this treatment option.
Funding: None
Surgery