Immediate Postoperative Activation of Vagus Nerve Stimulation (VNS) for Super-refractory Status Epilepticus: A Case Report

Anti-NMDA (N-methyl-D-aspartate) receptor encephalitis (ANRE) is a rare autoimmune condition targeting brain receptors, often linked to ovarian tumors in young women. In severe cases, it can lead to status epilepticus, but in sporadic cases, it may progress to super-refractory status epilepticus (SRSE), a dangerous state of continuous or repetitive seizures demanding urgent medical attention that continues or recurs more than 24 hours after the initiation of anesthetic therapy. We present a case report of anti-NMDA receptor limbic encephalitis-triggered SRSE terminated with vagus nerve stimulation (VNS) and titrated to high stimulation parameters in the immediate postoperative period. Titrating VNS to high stimulation parameters immediately postoperatively under specialized neuroanesthesia is a safe and effective treatment for nonconvulsive SRSE in anti-NMDA receptor limbic encephalitis. However, further research is needed to solidify this approach as a standard treatment option in these circumstances since the SRSE is rare. Expanding the evidence base will help improve patient outcomes and reduce morbidity and mortality associated with this condition.