A three-year-old boy, Nurlan Aman, from Kazakhstan, suffering from severe and recurrent seizures, presented to American Hospital Dubai. He was suffering from a form of epilepsy termed Drug-Resistant Epilepsy (DRE) or refractory seizures.
The cause of Aman’s DRE is unknown despite multiple investigations over the years, including MRI and whole genome sequencing.
Before coming to American Hospital Dubai, Aman had been treated with multiple medications to control his seizures. In total, the boy was on nine medications, but they failed to bring about a noticeable reduction in his seizures.
Aman’s parents approached Dr Ubaid Shah, a consultant pediatric neurologist and epileptologist at American Hospital Dubai, who undertook a thorough epilepsy evaluation of the three-year-old patient.
“For pediatric patients with uncontrolled epilepsy, there can be lifelong effects on their development. Hence, prompt diagnosis and tailored treatment is essential,” said Dr Shah. “About 30% of patients with epilepsy in children have drug-resistant epilepsy. These patients need to be seen by an epileptologist (neurologist with expertise and training in epilepsy),” he added.
Comprehensive evaluation of patients with epilepsy is crucial to determine the type of epilepsy, underlying cause and prognosis, said Dr Shah. “Many epilepsies in children are childhood epilepsies they grow out of. Determining underlying epilepsy syndrome is crucial in deciding the treatment pathway.”
Aman continues to be on 5 of 9 medications, but his drug-resistant condition requires a different approach. For DRE, doctors try specific techniques to help keep the seizures under better control, and one of them is putting the patient on a ketogenic diet.
So, Aman was started on a ketogenic diet. “(The keto diet) resulted in initial improvement, but then his seizures recurred,” said Dr Shah. After further evaluation, Dr Shah decided that the boy would benefit from Vagal Nerve Stimulation (VNS), a therapy often recommended for DRE.
VNS uses a small implantable device to induce a type of neuromodulation that changes the working of brain cells through electrical stimulation to the areas of the brain that cause seizures. It targets the vagus nerve, part of the autonomic nervous system responsible for automatic functions such as heartbeat and breathing. It is believed that nerve fibres within the vagus nerve connected to the part of the brain could be responsible for producing seizures.
The device stimulates the vagus nerve, delivering electrical signals at a specific pulse frequency for a certain time and in particular cycles. The impulse generation usually begins at a low level and, depending on the symptoms and need, can be increased as advised.
Hence, Vagus Nerve Stimulation therapy has been seen to reduce seizure periodicity significantly.
Dr Shah stresses the importance of candidate selection for VNS, a committed approach at American Hospital Dubai, whose mission is to deliver results-oriented treatment for its patients.
“Fortunately, many pediatric epilepsies can be treated successfully with one or two medications. It is important to correctly diagnose epileptic patients, as misdiagnosis is very common, especially in this region. It is crucial to identify the underlying cause of epilepsy, which determines the ideal treatment,” said Dr Shah.
There are many forms of epilepsy, such as focal epilepsy (originating from a single part of the brain), multifocal epilepsy (originating from several parts of the brain), generalized epilepsy (originating from both halves of the brain simultaneously) and other more complex forms.
“For focal epilepsy, there is the option of epilepsy surgery, which can cure epilepsy without the need for anti-seizure medications,” explained Dr Shah. “For drug-resistant epilepsies in those who are not candidates for resective epilepsy surgery, there may be other novel treatments available. Vagal Nerve Stimulation is one such treatment that offers significant chance of reducing seizures,” he clarified.
American Hospital Dubai performs a complete comprehensive evaluation of patients with epilepsy. It has a state-of-the-art Epilepsy Monitoring Unit, specialized MRI, PET Scan, and SPECT scans that help localize the origin of seizures within the brain to determine the candidacy for epilepsy surgery. The hospital can provide surgical options for epilepsy, even in very young children. “We also offer genetic testing to identify the gene defect causing epilepsy. It helps us design precision therapies targeting the underlying molecular defect,” Dr Shah added.
After a successful VNS device implant, Dr Shah is highly optimistic about the prognosis. “We expect Nurlan will have better seizure control as we adjust the device’s settings. We will also be able to reduce his medications, and he is expected to have a better quality of life.”
“We are very hopeful our son will catch up with his peers.”
Nurlan-Aman’s mother expresses her gratitude for the treatment by American Hospital Dubai:
“My son, Nurlan-Aman, was diagnosed with epilepsy at the age of 1.6 years. For two years, we have been trying to find a combination of medications that would stop his daily seizures. Unfortunately, his form of epilepsy is drug-resistant, and even putting him on a ketogenic diet did not stop his seizures.
Dr Ubaid Shah at American Hospital Dubai recommended Vagus Nerve Stimulation (VNS) therapy, and since we fully trust him, we agreed to the operation.
Dr Babak Homapour, consultant neurosurgeon, American Hospital Dubai, was patient and explained every detail and complication, making us feel safe and informed. The surgery went well, and we stayed one day in the ICU and flew back home to Kazakhstan in a couple of days.
We have turned on the VNS device and are in the process of upping the current. We are very hopeful that VNS will decrease the number of seizures and that our son will soon start speaking and catching up with his peers.
We thank American Hospital Dubai for their excellent support at every step. Their accurate diagnosis and knowledge helped our son receive the proper treatment.”
