Peripartum Management of Vagus Nerve Stimulation and Antiseizure Medications During Two Pregnancies in a Woman With Drug-Resistant Epilepsy: A Case Report.

There are limited reports on vagus nerve stimulation (VNS) therapy during pregnancy. We report a case of two pregnancies in a woman with drug-resistant epilepsy (DRE) managed with VNS. A woman with epilepsy underwent implantation of a VNS device because antiseizure medications (ASMs) and a lobectomy were not sufficient to control seizures. After a spontaneous pregnancy at 29 years old, she could continue epilepsy treatment as before pregnancy by only adjusting the VNS settings. A vaginal delivery was planned, but an emergency cesarean section was performed at 38 weeks' gestation due to chorioamnionitis, complicated by neonatal asphyxia and transient tachypnea of the newborn; both mother and infant recovered fully. Two years later, she conceived her second child spontaneously and continued ASM and VNS treatment as before, delivering by scheduled cesarean section at 37 weeks' gestation; the infant required treatment for transient tachypnea of the newborn but recovered well. This case illustrates that stable seizure control without ASM escalation is achievable during pregnancy in a patient with VNS-treated DRE whose seizures were well controlled before conception. However, the relative contribution of VNS itself cannot be determined from this experience.