Abstract
The patient, a 21-year-old right-handed female had a complex history of a treatment resistant genetic epilepsy with febrile seizures plus syndrome (GEFS+), chronic migraine headaches, major depressive disorder (MDD), and anxiety. The epilepsy, paternally inherited and shared with an older sister, was resistant to treatment with phenobarbital, oxcarbazepine, valproic acid, zonisamide, and levetiracetam. The best, albeit incomplete seizure control was achieved with a combination therapy that included lamotrigine, lacosamide and topiramate. The treatment resistant character of the patient’s epilepsy prompted implantation of a VNS, model Aspire SR106. Gradual stimulation adjustment from a current output of 0.375 mA to 0.625 mA resulted in a reported full seizure control with only one breakthrough focal to bilateral tonic-clonic seizure triggered by a school-related stress and sleep deprivation in a 12-month period. The patient also experienced an improvement in mood and headaches.
- Received July 26, 2020.
- Accepted December 14, 2020.
- © 2021 American Academy of Neurology
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