Severe Recurrence of Seizures Following Pandemic-Related Delay of Stimulator Servicing

The 45-year-old patient has suffered from genetically confirmed progressive myoclonic epilepsy since the age of 8 years. The clinical picture was long dominated by action myoclonus, drop seizures caused by myoclonus, and generalized tonic–clonic seizures that tended to occur as status epileptici. These phenomena persisted, despite pharmacological treatment with combinations of benzodiazepines, valproate, phenobarbital, zonisamide, and levetiracetam, until stimulation treatment of the anterior thalamic nuclei was initiated in 2011. The thalamic stimulation barely had any effect on the myoclonus, but brought the patient’s tonic–clonic seizures completely under control for a number of years. Then, in 2020, came the COVID-19 crisis. Hospitals were directed to care for emergency cases only, leading to cancellation of the regular 3-monthly visits to monitor stimulator functionality and seizure control. Although the patient’s treatment was not modified, he again started to have tonic–clonic seizures resulting in fall injuries. When he could eventually be monitored, inspection of the stimulator revealed a declining battery charge; in this emergency scenario, surgical stimulator replacement was necessary to bring the severe seizures back under control. This case clearly illustrates how restrictions on the elective management of chronically ill patients with stimulators may lead to life-threatening deterioration requiring involvement of the emergency medical services and urgent interventions.

Figure

Stimulation system with targets in the anterior thalamic nuclei as third-line treatment for patients with pharmacoresistant epilepsy

Prof. Dr. med. Andreas Schulze-Bonhage, Dr. med. Martin Hirsch, Epilepsiezentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universitätsklinikum Freiburg, [e-mail]

Prof. Dr. med. Volker Arnd Coenen, Abteilung Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universitätsklinikum Freiburg

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated: from the original German by David Roseveare.

Cite this as: Schulze-Bonhage A, Hirsch M, Coenen VA: Severe recurrence of seizures following pandemic-related delay of stimulator servicing. Dtsch Arztebl Int 2022; 119: 541. DOI: 10.3238/arztebl.m2022.0063