Trigeminal neuralgia-like pain in a vagus nerve stimulation super-responder with drug-resistant idiopathic generalized epilepsy: A case report

TL;DR

A man with drug-resistant epilepsy became seizure-free with VNS but later experienced rare facial pain linked to the treatment.

Contribution

This case highlights TNLP as a rare side effect of VNS and suggests pharmacological treatment may be necessary.

Findings

The patient became seizure-free after VNS implantation.

TNLP occurred in sync with VNS stimulation and persisted after parameter adjustments.

Pregabalin provided partial relief from TNLP while maintaining seizure control.

Abstract

•VNS is an effective adjunctive treatment in drug-resistant IGE.•TNLP is a rare side effect of VNS therapy.•Pharmacological treatment may be needed if TNLP persists after reprogramming.

VNS is an effective adjunctive treatment in drug-resistant IGE.

TNLP is a rare side effect of VNS therapy.

Pharmacological treatment may be needed if TNLP persists after reprogramming.

We report a 38-year-old man with drug-resistant idiopathic generalized epilepsy (IGE) who became seizure-free after being implanted with vagus nerve stimulation (VNS). He developed a trigeminal neuralgia-like pain (TNLP) time-locked with ON stimulations. TNLP did not cease after restoring the initial stimulation parameters. After an unsuccessful trial with carbamazepine, the patient reported a moderate improvement with pregabalin. He remained seizure-free, being able to partially rationalize his ASM therapy and the ability to start driving lessons, with the normalization of his routine electroencephalogram (EEG).

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