Abstract
A 3.5-year-old female from Palestine presented to Jordan Hospital with pharmaco-resistant epilepsy. She was diagnosed with tuberous sclerosis (TS) at six months of age. Onset of seizure activity, consisting of twitching and eye deviation, was noted at age one month. Her symptoms quickly progressed to infantile spasms. Various medications and dietary changes were implemented but without sustained seizure control. The patient underwent a vagal nerve stimulation procedure as a last resort to reduce seizure burden and frequency. Pharmaco-resistant epilepsy is defined as the failure of a patient′s seizures to respond to at least two antiepileptic medications that are appropriately chosen and used for an adequate period. Our protocol for vagal nerve stimulation for this age is to start with a stimulus level at 0.25 milliampere and increase it gradually until we reach 2.5 milliampere within six months. Vagal nerve stimulation proved to be a relatively effective method at reducing the frequency and severity of seizures in this case of pharmaco-resistant epilepsy due to TS. It is available to children even in some limited resource settings. Challenges remain for follow-up of in the setting of social unrest.
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