Vagus nerve stimulation is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or had poor results after surgical procedures. Its mechanism of action is not yet fully comprehended but it possibly involves modulation of the locus coeruleus, thalamus and limbic circuit through noradrenergic and serotonergic projections. There is sufficient evidence to support its use in patients with focal epilepsy and other seizure types. However, it should be recognized that improvement is not immediate and increases over time. The majority of adverse events is stimulation-related, temporary and decreases after adjustment of settings. Future perspectives to improve efficacy and reduce side effects, such as different approaches to increase battery life, transcutaneous stimulation and identification of prognostic factors, should be further investigated.Keywords: vagus nerve stimulation; epilepsy. RESUMOA estimulação vagal é uma terapia paliativa utilizada no tratamento de pacientes com epilepsia refratária que não são candidatos à cirurgia ressectiva ou naqueles com evolução insatisfatória após o procedimento cirúrgico. Seu mecanismo de ação ainda não foi completamente elucidado mas possivelmente envolve a modulação do locus coeruleus, tálamo e circuito límbico através de projeções noradrenérgicas e serotoninérgicas. Atualmente há evidência suficiente para corroborar o uso desta terapia em pacientes com epilepsia focal e outros tipos de crise, com resultados que, apesar de não imediatos, melhoram progressivamente no longo prazo. Os eventos adversos são, em sua maioria, relacionados à estimulação e auto-limitados. Perspectivas futuras para aumentar a eficácia e reduzir os efeitos colaterais como a utilização de baterias com maior durabilidade, estimulação transcutânea e identificação de fatores prognósticos devem ser investigadas. Palavras-chave: estimulação do nervo vago; epilepsia.Epilepsy is one of the most common chronic neurologic diseases and affects at least 50 million people worldwide 1 . Although much has been understood about its causes, epilepsy is still extremely stigmatizing and many patients are victims of prejudice and social exclusion. The quality of life of those affected by the disease is remarkably compromised due to seizures, antiepileptic drugs (AED), cognitive impairment and physical limitations.Those who do not achieve adequate seizure control, even with multiple AED trials, are considered refractory. Currently, medically resistant epilepsy is regarded as a worldwide health issue as it is endured by approximately one third of epileptic patients. The financial burden is substantial and, among all health costs of uncontrolled patients, nearly 50% are related to epilepsy care costs 2 . For these individuals, whose treatment is generally complex, epilepsy surgery may be indicated and can provide up to 80% seizure control, depending on distinct aspects such as time of follow-up and epileptic focus localization. Figure 1 illustrates the therapy ...

Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.

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The present report is about a 25-year-old woman who had a motorcycle accident with brain trauma injury. Although she was admitted at another institution disoriented but alert, she progressively evolved to an altered level of consciousness and required orotracheal intubation. She was then transferred to our hospital sedated, and the admission head computed tomography showed signs of posterior fossa ischemia. The angiography demonstrated a vertebral artery dissection with subsequent embolization to the basilar artery, which provoked its complete occlusion. After drug withdrawal, the patient recovered level of consciousness but was aphasic and did not exhibit purpose movements apart from eye blinking, as expected in patients with locked-in syndrome.

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