Zadovoljavajući ishod primene stimulacije vagusnog nerva u lečenju bolesnika sa epilepsijom rezistentnom na lekove nastalom usled periventrikularne nodularne heterotopije

  • Stefan Todorović University Clinical Center Niš, Department of Neurology, Niš, Serbia
  • Boban Biševac University Clinical Center Niš, Department of Neurology, Niš, Serbia
  • Stevo Lukić University Clinical Center Niš, Department of Neurology, Niš, Serbia
  • Jovan Ilić University Clinical Center Niš, Department of Neurosurgery, Niš, Serbia
  • Dejan Aleksić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP230217046T
Ključne reči: mozak, anomalije, epilepsija, farmakorezistentna, epilepsija, parcijalna, magnetska rezonanca, snimanje, tomografija, pozitron-emisiona, n. vagus, stimulacija

Sažetak


Uvod. Periventrikularna nodularna heterotopija (PNH) predstavlja malformaciju u razvoju kore velikog mozga koja se karakteriše abnormalnom migracijom neurona u kortikalnu ploču i često je povezana sa fokalnom epilepsijom rezistentnom na lekove. Prikaz bolesnika. Bolesnica stara 33 godine patila je od farmakorezistentne epilepsije, koju su pretežno karakterisali fokalni napadi, sa povremenim napadima koji su  imali fokalni početak i širili se u bilateralne toničko-kloničke napade. Nalazima magnetne rezonance pokazano je da bilateralno postoje  heterotopični čvorovi duž okcipitalnih rogova bočnih komora mozga. Nalaz 18-Fluoro-deoxyglucose positron emission tomography – FDG-PET skenera je pokazao postojanje zone smanjenog metabolizma glukoze u desnom temporalnom regionu. Elektroencefalogram je ukazao na fokalnu elektrokortikalnu aktivnost u temporo-parijeto-okcipitalnim regionima, pretežno temporalno desno. Bolesnica je lečena politerapijom (valproična kiselina, lamotrigin, levetiracetam, okskarbazepin, pregabalin, klobazam, lakozamid) koja nije uticala na učestalost epileptičkih napada. Zbog bilateralne lokalizacije heterotopičnih čvorova, hirurški način lečenja nije bio preporučljiv. Nakon multidisciplinarnog sagledavanja, odlučili smo se za stimulaciju vagusnog nerva (SVN) i postigli zadovoljavajuću kontrolu epileptičkih napada. Zaključak. Bolesnici sa PNH zahtevaju multidisciplinarno sagledavanje i lečenje, dok u ovom  slučaju  imamo primer  bolesnice  kod koje je postignuta zadovoljavajuća kontrola farmakorezistentne epilepsije nakon implantacije uređaja za SVN.

Biografije autora

Stefan Todorović, University Clinical Center Niš, Department of Neurology, Niš, Serbia

Klinika za neurologiju Univerzitetskog Kliničkog Centra u Nišu

Jovan Ilić, University Clinical Center Niš, Department of Neurosurgery, Niš, Serbia

broj telefona- +381/64-883-93-85

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Objavljeno
2023/12/29
Broj časopisa
Vol. 80 Br. 12 (2023): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika