Transcutaneous vagus nerve stimulation for the treatment and prevention of non-epileptic seizure disorder: A case study

Abstract

Non-epileptic seizures (NES) are paroxysmal events resembling epileptic seizure but are not accompanied by electroencephalographic changes. Like epileptic seizure, NES can be associated with aura. NES is a frank disability where 1/3 of patients undergo a chronic intractable course resulting in significant disability and lack of community integration. To describe the application of transcutaneous vagus nerve stimulation (TVNS) for the treatment and prevention of NES. A 34 y/o female patient presented for chronic fibromyalgia and migraine headache (MHA) management with a 15-year history of intractable NES unresponsive to psychotherapy or medical management. Aura for her MHA and NES overlapped. Patient had multiple medication sensitivities and allergies with a high disability index. TVNS was prescribed for the MHA. In using the TVNS at times of aura to prevent MHA, patient experienced a significant reduction in episodes of NES (2–4/month to 1/month) and severity of NES symptoms notably intensity of motor symptoms (left-sided body convulsions) and episode duration (from an average of 10–15 min to 2–5 min.) The patient commented that she “finally felt she had the power to do something” about her NES and felt more confident going into public places. This case study demonstrates a significant reduction in episodes and symptoms of a female patient with NES disorder with aura after application of TVNS. Given this, we are further piloting TVNS for the prevention and treatment of NES (with or without aura) with a prescriptive daily and as needed dosing.