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Epilepsia Open. 2018 Jan 11;3(1):103-108. doi: 10.1002/epi4.12094. eCollection 2018 Mar.

The adjunctive application of transcranial direct current stimulation in the management of de novo refractory epilepsia partialis continua in adolescent-onset POLG-related mitochondrial disease.

Author information

1
Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle United Kingdom.
2
Department of Paediatric Neurology Royal Victoria Infirmary Newcastle upon Tyne United Kingdom.
3
Department of Clinical Neurophysiology Royal Victoria Infirmary Newcastle United Kingdom.
4
Department of Paediatrics City Hospitals Sunderland NHS Foundation Trust Sunderland United Kingdom.
5
Institute of Neuroscience Newcastle University Newcastle upon Tyne United Kingdom.

Abstract

Focal status epilepticus in POLG-related mitochondrial disease is highly refractory to pharmacological agents, including general anesthesia. We report the challenges in managing a previously healthy teenager who presented with de novo epilepsia partialis continua and metabolic stroke resulting from the homozygous p.Ala467Thr POLG mutation, the most common pathogenic variant identified in the Caucasian population. We applied transcranial direct current stimulation (tDCS; 2 mA; 20 min) daily as an adjunctive therapy because her focal seizures failed to respond to five antiepileptic drugs at maximal doses. The electrical and clinical seizures stopped after 3 days of tDCS. The second course of tDCS was administered for 14 days when the focal seizures re-emerged a month later. The patient tolerated the procedure well. Following 4 months of hospitalization and prolonged community rehabilitation, our patient has now returned to full-time education with support, and there is no report of cognitive deficit. We have demonstrated the safety and efficacy of tDCS in treating refractory focal motor seizures caused by mitochondrial disease.

KEYWORDS:

Focal seizures; Mitochondrial disease; Neurostimulation; Refractory status epilepticus

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