Satisfying outcome in a patient with drug-resistant epilepsy due to periventricular nodular heterotopia treated with vagus nerve stimulation

Introduction. Periventricular nodular heterotopia (PNH) is a malformation of cortical development which is characterized by abnormal migration of neurons to the cortical plate and is very often linked to drug -resistant focal epilepsy. Case report. A 33-year-old woman with a severe drug-resistant epilepsy is presented. She suffered from focal epilepsy predominantly characterized by focal seizures and occasionally focal to bilateral tonic-clonic seizures. Magnetic resonance imaging showed bilateral heterotopic nodules in the occipital horns of the lateral ventricles. 18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) scan demonstrated a zone of reduced glucose metabolism on the right temporal region. Electroencephalogram suggested focal electrocortical activity on the temporo-parieto-occipital regions, predominantly on the temporal right. The woman was treated with polytherapy (valproic acid, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, clobazam, lacosamide) but it did not affect the seizure frequency. Surgical treatment was not recommended due to bilateral localization of the heterotopic nodules. We decided on vagus nerve stimulation (VNS) and achieved satisfying seizure control. Conclusion. Patients with PNH require multidisciplinary assessment and treatment, while this report represents a case of a patient with satisfying seizure control after the VNS implantation.