Abstracts

Safety of Accelerated Titration of Vagus Nerve Stimulator for Super Refractory Status Epilepticus: A Single-institution Case Series

Abstract number : 2.459
Submission category : 9. Surgery / 9C. All Ages
Year : 2024
Submission ID : 719
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Karen Camarena-Rubio, MD – Instituto Nacional de Neurología y Neurocirugía

Diego Pichardo-Rojas, MD – Instituto Nacional de Neurologia y Neurocirugia
Jonathan Macias-Lopez, MD – National Institute of Neurology and Neurosurgery
Manuel Alejandro del Río-Quiñones, MD – Instituto Nacional de Neurología y Neurocirugía
Sonia Mejia Perez, MD – Instituto Nacional de Neurología y Neurocirugía
Elma Paredes-Aragon, MD – National Institute of Neurology and Neurosurgery
Laura Hernandez Vanegas, MD – Instituto Nacional de Neurología y Neurocirugía

Rationale: Super Refractory Status Epilepticus (SRSE) is a condition with high in-hospital morbimortality, characterized by the persistence of status epilepticus when patients are weaned off Anesthetizing Anti-Seizure Medications (A-AS) over a period of 24 hours. Vagus Nerve Stimulation (VNS) has been shown to be safe and efficacious in the treatment of drug resistant epilepsy (DRE). In this study, we explore the safety of VNS for SRSE, and what parameters we have found safe for patients when turning on the device immediately after surgery.

Methods: We present a retrospective case series on patients who were implanted with VNS as a surgical neuromodulation therapy for SRSE. All patients had their VNS titrated to high stimulation parameters immediately after surgery, under specialized neuroanalgesia provided by Neuroanesthesia specialists, and subsequently monitored by the Intensive Care Unit.

Results: Three patients were implanted with VNS for SRSE; and subsequently turned on the device in the first 20 minutes post-operatively. All devices were Livanova M106 models. Initial parameters varied amongst the following: Normal stimulation: 1mA-1.5mA, frequency of 30Hz,500ms on-time 30 seconds, off-time 5 minutes, Autostim parameters: 1.25-1625mA, with a 60 second on-time, and Magnet mode at a stimulation for 1.5-1.75mA. Analgesia was provided through fentanyl (⅔ patients), acetaminophen (⅔ patients), tramadol (⅔ patients), dexmetomedine (⅔ patients), or clonixin (⅓ patients). All patients were able to wean off A-AN in 2-7 days with no relapse of SRSE, and no report of adverse effects (Table 1).



Conclusions: Contrasting previous studies, which would titrate stimulation along 1-3 days, we found that rapid titration of VNS stimulation utilizing high parameters is a safe and effective tool in the treatment of SRSE under appropriate analgesia. More studies reporting safe and effective neuromodulatory parameters on larger samples are necessary to appropriately assess the viability of VNS for SRSE. In addition, long-term sustained effect of VNS neuromodulation effect is also unknown with this rapid titration.

Funding: Self-funded

Surgery