Treatment of Refractory Status Epilepticus with Vagus Nerve Stimulator in an Elderly Patient.

Abstract

One of the risks of a traumatically induced intracranial bleed is development of new onset seizures. Rarely would these seizures progress to status epilepticus (SE) or refractory SE. There is a lack of literature on the use of a vagus nerve stimulator in these situations in older adults. We present a 67-year-old patient who developed refractory status epilepticus within days after evacuation of a right-sided spontaneous subdural hematoma. He was refractory to multiple antiepileptic agents and phenobarbiturate- and propofol-induced coma. He then underwent a left vagus nerve stimulator (VNS) implantation. Within a few days of implantation, he improved dramatically. Within 2 weeks of VNS implantation, he was neurologically intact and was transferred to an inpatient rehabilitation facility. Within a short time thereafter, he was fully functional and able to take care of all of his activities. A vagus nerve stimulator should be considered in cases of refractory status epilepticus, regardless of age. Excellent outcome can be achieved even if a short course of medication-induced coma is unsuccessful.