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Vagus nerve stimulation as a potential modulator of periictal psychotic episodes: A report of four cases
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Drug resistant epilepsy (DRE) has been associated with a high incidence of psychotic disorders. Patients can develop psychosis after starting a new antiseizure medication, after undergoing resective surgery, or after implantation of a vagus nerve stimulation (VNS) system. The aim of this study was to investigate the modulation effect of VNS on psychotic episodes in DRE patients with a pre-existing history of periictal psychotic episodes (PPE). We retrospectively report the outcome of four patients from a single tertiary center with PPE prior to implantation. None of the implanted patients developed de novo PPE after VNS therapy. Regarding seizure outcome, all patients demonstrated a response to VNS with two who experienced who status epilepticus and three patients wtih a change in semiology with after VNS implantation. PPE disappeared in all the study patients, two of them at 6 months post-implantation and in the others after 2 and 3 years, respectively. 18F-FDG-PET results showed hypermetabolism in both anterior insular and medial frontal lobes which disappeared in the 18F -FDG-PET 4 years post-implantation. Based on the results of this series of cases we suggest that VNS therapy may be useful to modulatet PPE in patients with DRE, though effectiveness may be time-dependent.
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ALEMANY, Montse, REAL, Eva, CUSTAL, Núria, SALA PADRÓ, Jacint, RODRÍGUEZ BEL, Laura, PLANS, Gerard, MORA GRAUPERA, Jaume, SANTURINO, Mila, VANCAMP, Tim, FALIP, Mercè. Vagus nerve stimulation as a potential modulator of periictal psychotic episodes: A report of four cases. _Epilepsy & Behavior Reports_. 2021. Vol. 15. [consulta: 12 de abril de 2026]. [Disponible a: https://hdl.handle.net/2445/178234]