Scribd Logo
Upload

Welcome to Scribd!

  • Vagal Nerve Stimulation

    Uploaded by

    Jabraan J
    9 views8 pages
    Mr. Lo is a 22-year-old man with a history of seizures since childhood including infantile spasms as an infant that resolved after treatment. His current seizures began at age 8 and include focal seizures with impaired awareness and generalized seizures with hypertonia. MRI shows possible left frontal cortical dysplasia. Multiple antiepileptic drugs have failed to control his seizures. His most recent EEG captured a tonic seizure and showed generalized paroxysmal fast activity and slow spike waves from the frontocentral region. Brain MRI was unchanged and showed no obvious surgical target. He is currently taking multiple AEDs and was approved for a VNS implant in September 2023.

    Original Description:

    Original Title

    Vagal Nerve Stimulation (1)

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Mr. Lo is a 22-year-old man with a history of seizures since childhood including infantile spasms as an infant that resolved after treatment. His current seizures began at age 8 and include focal seizures with impaired awareness and generalized seizures with hypertonia. MRI shows possible left frontal cortical dysplasia. Multiple antiepileptic drugs have failed to control his seizures. His most recent EEG captured a tonic seizure and showed generalized paroxysmal fast activity and slow spike waves from the frontocentral region. Brain MRI was unchanged and showed no obvious surgical target. He is currently taking multiple AEDs and was approved for a VNS implant in September 2023.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views8 pages

    Vagal Nerve Stimulation

    Uploaded by

    Jabraan J
    Mr. Lo is a 22-year-old man with a history of seizures since childhood including infantile spasms as an infant that resolved after treatment. His current seizures began at age 8 and include focal seizures with impaired awareness and generalized seizures with hypertonia. MRI shows possible left frontal cortical dysplasia. Multiple antiepileptic drugs have failed to control his seizures. His most recent EEG captured a tonic seizure and showed generalized paroxysmal fast activity and slow spike waves from the frontocentral region. Brain MRI was unchanged and showed no obvious surgical target. He is currently taking multiple AEDs and was approved for a VNS implant in September 2023.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 8

    Preoperative discussion

    Mr Lo.
    • 22 years old
    • History of brief head drop as infant (?infantile spasm), treatead briefly with anticonvulsant
    which resolved after few months.

    • History of seizure at age 8years old


    • Noted by family members head turning to the left with Impaired awareness
    • Lasting for few seconds
    • Numerous episodes per day
    • Seizure semiology varies from focal seizures with impaired awareness to those of generalised onset with
    hypertonia
    • EEG done in March 2009: Focal onset left midfrontal region, associated fidgety behaviors.
    • MRI- possible cortical dysplasia over left frontal region, anterior to opercular region and Broca’s area.
    • Started on Trileptal 600mg BD, lamotrigine 100mg BD, Epilim 500mg OD and Clobazam 15mg BD.
    • Seizure not controlled.
    • Started on Fycompa 2mg ON
    Past Medical History
    • History of infantile spasms diagnosed at 1.5 years old
    • Lasted few months
    • Claimed self-resolved
    • Seizures recurred at age of 8years with some years of seizure freedom
    resulting in stopped medication
    • Symptoms recurred at age of 13 and patient started on medication
    AED history
    Old medications
    • T. Trileptal 600mg bd
    • T. Lamotrigine 100mg BD
    • T Epilim 500mg BD
    • T Clozabam 15 mg BD

    • Due to still having seizures, patient was started on Fycompa 2mg ON


    • Trileptal titrated off in Feb 2023 and started on carbamazepine since March 2023
    • Trial of rufinamide but worsened seizure

    • Current medications
    • Carbamazepine CR 600mg/ 400mg BD
    • Lamotrigine 100mg BD
    • Fycompa 8mg ON
    • Clobazam 20mg BD
    Investigation latest
    • EEG 27/04/22
    • Epileptiform activity (heterogenous) with background of 9-10Hz
    • Generalised paroxysmal fast activity
    • Slow spike and slow waves from frontocentral region (2-2.5Hz)
    • Captured one episode of tonic seizure with typical tonic signature (LGS like
    phenotype)

    • MRI (2022)
    • No evidence of focal cortical dysplasia, no mesial temporal lobe seizure
    • Brain atrophic to age
    • No obvious surgical target
    • (suspicious left frontal sulcus extension but no definite change on T1)
    On examination
    • patient normal built gentleman
    • GCS 15, FOUR 16
    • No neurocutaneous sign
    • MMSE
    • Neurological examiantion
    Implant
    • VNS approved in September 2023
    History to ask
    Seizure history / semiology/ frequency
    Compliant/ supervision
    History of ICU admission
    Video EEG
    Last seizure
    mood
    Physical examination
    HMF

    You might also like