# 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.

## Key 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).