RESUMO
Vagus nerve stimulation (VNS) is an additive treatment option for refractory epilepsy. The electrode is placed on the cervical trunk of the left vagus nerve. In patients who are not suitable for left-sided vagus nerve stimulation (L-VNS) right-sided vagus nerve stimulation (R-VNS) may be as effective. In animal models epilepsy is sufficiently suppressed by R-VNS. In a 16 years old boy suffering from medically refractory psychomotoric seizures with secondary generalisation, L-VNS reduced the frequency of generalized seizures. A deep wound infection required the removal of the system eight weeks later. Cicatrisation did not allow preparation of the left vagus nerve, therefore we implanted R-VNS with sufficient seizure suppression. However, compared to L-VNS, the effect occurred months later and cardiac symptoms were induced by stimulation of the right vagus nerve. R-VNS seems to be an effective and alternative therapy in selected patients responding to L-VNS where a left-sided reimplantation is not possible. Placement and adjustment of the device should be performed under ECG control. Further studies are necessary to compare the efficacy of L-VNS and R-VNS.
Assuntos
Terapia por Estimulação Elétrica/métodos , Epilepsia Parcial Complexa/terapia , Nervo Vago/fisiologia , Adolescente , Animais , Anticonvulsivantes/uso terapêutico , Bradicardia/etiologia , Dano Encefálico Crônico/complicações , Remoção de Dispositivo , Resistência a Medicamentos , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados/efeitos adversos , Epilepsia Parcial Complexa/complicações , Epilepsia Parcial Complexa/tratamento farmacológico , Epilepsia Generalizada/tratamento farmacológico , Epilepsia Generalizada/etiologia , Epilepsia Generalizada/terapia , Rouquidão/etiologia , Humanos , Masculino , Ratos , Comportamento Autodestrutivo , Nó Sinoatrial/fisiopatologia , Especificidade da Espécie , Infecção da Ferida Cirúrgica/complicaçõesRESUMO
We describe a follow-up in a 15-year-old boy with neuroborreliosis diagnosed by clinical symptoms, CSF and serum analysis. MRI revealed a thalamic lesion and an enhancement of the right trigeminal nerve clinically associated with mild hypasthesia in the right maxillary region. Both, clinical symptoms and radiological findings disappeared within 2 months after treatment. Borrelia burgdorferi specific IgM and IgG in CSF and IgG in serum became negative between 6 and 12 months after diagnosis. We show that neuroborreliosis at an early stage may present only with moderate neurological deficits and that at this stage MRI reveals distinct cerebral lesions which might even precede clinical manifestation. Thus, early diagnosis and treatment of neuroborreliosis may prevent persistent neurologic lesions.