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Case Report
Pharmaco-resistant epilepsy in tuberous sclerosis: A case report
1 MD Candidate, School of Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas, United States of America
2 MD, Professor, Department of Pediatrics, University of Texas Medical Branch (UTMB), Galveston, Texas, United States of America
3 MD, Department of Pediatrics, Jordan Hospital, Amman, Jordan
4 MD, FAAP, Chairperson, Department of Pediatrics, Jordan Hospital, Amman, Jordan
5 MD, MPH, Director of Programs and Adjunct Assistant Professor, Center for Global and Community Health and Department of Pediatrics, University of Texas Medical Branch (UTMB), Galveston, Texas, United States of America
Address correspondence to:
Hani Serag
MD, MPH, The University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, Texas 77555-0920,
United States of America
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Article ID: 100091Z06SH2021
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Hussein S, Beach P, Khan M, Jabr M, Halazun J, Serag H. Pharmaco-resistant epilepsy in tuberous sclerosis: A case report. Case Rep Int 2021;10:100091Z06SH2021.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.
Keywords: Pediatrics, Pharmaco-resistant epilepsy, Tuberous sclerosis, Vagal nerve stimulation
SUPPORTING INFORMATION
Acknowledgments
We would like to acknowledge and thank Dr. Abdalla Bashir, MD, FRCSEd, FACS, the chairman of the board of directors of the Jordan Hospital in Amman, Jordan, for his outstanding support to along all stages of this work.
Author ContributionsSarah Hussein - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Patricia Beach - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Maryam Khan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mariam Jabr - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jarir Halazun - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hani Serag - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Sarah Hussein et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
