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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

Lookup NU author(s): Dr Yi NgORCiD, Dr Henriette van Ruiten, Dr Vankateswara Ramesh, Professor Robert Taylor, Emeritus Professor Doug Turnbull, Professor Grainne Gorman, Professor Bobby McFarlandORCiD, Dr Mark BakerORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2017 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy. 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.


Publication metadata

Author(s): Ng YS, van Ruiten H, Lai HM, Scott R, Ramesh V, Horridge K, Taylor RW, Turnbull DM, Gorman GS, McFarland R, Baker MR

Publication type: Article

Publication status: Published

Journal: Epilepsia Open

Year: 2018

Volume: 3

Issue: 1

Pages: 103-108

Print publication date: 01/03/2018

Online publication date: 06/12/2017

Acceptance date: 20/11/2017

Date deposited: 23/04/2019

ISSN (electronic): 2470-9239

Publisher: Wiley-Blackwell Publishing Ltd

URL: https://doi.org/10.1002/epi4.12094

DOI: 10.1002/epi4.12094


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Funding

Funder referenceFunder name
Lily Foundation
Mitochondrial Disease Patient Cohort (UK). Grant Number: G0800674
Medical Research Council (MRC) Centre for Translational Research in Neuromuscular Disease
Newcastle University Centre for Ageing and Vitality
NIHR
UK NIHR Biomedical Research Centre for Ageing and Age‐Related Disease award to the Newcastle upon Tyne Foundation Hospitals NHS Trust
UK MRC
UK NHS Highly Specialised Service for Rare Mitochondrial Disorders of Adults and Children
Wellcome Centre for Mitochondrial Research. Grant Number: 203105

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