PMC8769382_01
Magnetic resonance T2-weighted imaging 76 days after birth detected bilateral periventricular leukomalacia.
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Magnetic resonance imaging (MRI) conducted 76 days after birth revealed bilateral periventricular leukomalacia (Fig. 1).
Interictal awake electrocorticogram before VNS. The results revealed diffuse spikes and slow waves with bursts lasting a few seconds, predominantly in the frontal and parietal regions. VNS: vagus nerve stimulation.
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Interictal awake EEG under IV-MDZ showed diffuse spikes and slow waves, predominantly in the parietal and occipital regions (Fig. 2).
Clinical course after VNS. (A) Effect of VNS on the number of SCs (solid line). The series of SCs clearly decreased after VNS. VNS output current (dotted line) gradually increased up to 2.5 mA after rapid induction up to 1.5 mA. (B) AEDs used after VNS. PB, KBr, and CLB were continued, but ZNS was replaced with CBZ until week 45 after VNS. The dose of IV-MDZ was gradually decreased and discontinued 4 weeks after inducing VNS. AEDS: anti-epileptic drugs, CBZ: carbamazepine, CLB: clobazam, IV-MDZ: intravenous midazolam, KBr: potassium bromide, PB: phenobarbital, SCs: seizure clusters, VNS: vagus nerve stimulation, ZNS: zonisamide.
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Figure 3 shows the clinical course after VNS implantation.
Interictal awake electroencephalogram 21 months after VNS. Spikes and waves seen before VNS disappeared during the recording; however, sporadic spikes still appeared. VNS: vagus nerve stimulation.
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EEG performed 21 months after VNS revealed that the spike waves had disappeared, and the frequency of sporadic spikes had decreased (Fig. 4).