Super-rapid titration of vagus nerve stimulation in a patient with DEPDC5-related drug-resistant epilepsy

Pathogenic mutations in DEPDC5 are responsible for a broad range of focal lesional and non-lesional epilepsies. Drug resistance and normal structural neuroimaging findings are common in more than half of patients. Neuromodulation techniques like vagus nerve stimulation (VNS) might be particularly attractive for those patients who are less likely to have a good outcome from surgical resection due to normal neuroimaging or whose epileptogenic zone involves eloquent regions, which if disrupted by resection could leave new deficits. Here, we report the super-rapid titration of stimulation, starting on the day of implantation, of a VNS Model 1000 without complications in an 18-year-old woman with drug-resistant non-lesional DEPDC5-related focal epilepsy experiencing very frequent seizures. This achieved ≥50 % seizure reduction, allowing reduction of the burden of medication.