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Muthiah N, Sharma N, Vodovotz L, White GE, Abel TJ. Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy. J Neurosurg Pediatr 2022; 30:284-291. [PMID: 35901694 DOI: 10.3171/2022.6.peds2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complications from vagus nerve stimulator (VNS) procedures are common and can have important implications for morbidity and seizure control, yet predictors of complications are poorly understood. The objective of this study was to assess clinical factors associated with minor and major complications from VNS procedures among pediatric patients with drug-resistant epilepsy. METHODS The authors performed an 11-year retrospective review of patients who underwent VNS procedures for drug-resistant epilepsy at age < 21 years. The primary outcome was complications (minor or major) following VNS surgery. Preoperative and surgery characteristics were compared between patients who developed versus those who did not develop complications. Multivariable Poisson regression was performed to determine the association between preoperative characteristics and infection. RESULTS Of 686 surgeries, 48 complications (7.0%) developed; there were 7 minor complications (1.0%) and 41 major complications (6.0%). Surgeries with minor complications were an average of 68 minutes longer than those without minor complications (p < 0.001). The incidence rate of infection was 1 per 100 person-years, with 3% of procedures complicated by infection. Poisson regression revealed that after adjusting for age at surgery, duration of surgery, and primarily motor seizure semiology, the incident rate of infection for revision surgeries preceded by ≥ 2 procedures was 19 times that of first-time revisions. CONCLUSIONS The overall minor complication rate was 1% and the overall major complication rate was 6% for VNS procedures. Longer surgery duration was associated with the development of minor complications but not major complications. Repeat incisions to the VNS pocket may be associated with higher incident rate of infection, highlighting a need for longer-lasting VNS pulse generator models.
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Affiliation(s)
| | - Nikhil Sharma
- 1Department of Neurological Surgery, University of Pittsburgh
| | - Lena Vodovotz
- 1Department of Neurological Surgery, University of Pittsburgh
| | - Gretchen E White
- 2Institute for Clinical Research Education, University of Pittsburgh; and
| | - Taylor J Abel
- 1Department of Neurological Surgery, University of Pittsburgh
- 3Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Noris A, Roncon P, Peraio S, Zicca A, Lenge M, Di Rita A, Genitori L, Giordano F. Complete section of the left vagus nerve does not preclude the efficacy of vagus nerve stimulation: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21128. [PMID: 35854913 PMCID: PMC9265221 DOI: 10.3171/case21128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/02/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) represents a valid therapeutic option for patients with medically intractable seizures who are not candidates for epilepsy surgery. Even when complete section of the nerve occurs, stimulation applied cranially to the involved nerve segment does not preclude the efficacy of VNS. Complete vagus nerve section with neuroma causing definitive left vocal cord palsy has never been previously reported in the literature. OBSERVATIONS Eight years after VNS implant, the patient experienced worsening of seizures; the interrogation of the generator revealed high impedance requiring surgical revision. On surgical exploration, complete left vagus nerve section and a neuroma were found. Vocal cord atrophy was found at immediate postoperative laryngeal inspection as a confirmation of a longstanding lesion. Both of these events might have been caused by direct nerve injury during VNS surgery, and they presented in a delayed fashion. LESSONS VNS surgery may be complicated by direct damage to the left vagus nerve, resulting in permanent neurological deficits. A complete section of the nerve also enables an efficacious stimulation if applied cranially to the involved segment. Laryngeal examination should be routinely performed before each VNS surgery to rule out preexisting vocal cord dysfunction.
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Affiliation(s)
- Alice Noris
- Neurosurgery Unit, Department of Neurosciences, and
| | - Paolo Roncon
- Anesthesiology and Intensive Care Unit, Meyer Children’s Hospital, Florence, Italy; and
| | | | - Anna Zicca
- Medical Affairs Department, Sorin Group Italia, LivaNova PLC-Owned Subsidiary, Milan, Italy
| | - Matteo Lenge
- Neurosurgery Unit, Department of Neurosciences, and
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Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation. Eur Arch Otorhinolaryngol 2021; 278:3891-3899. [PMID: 34196736 PMCID: PMC8382619 DOI: 10.1007/s00405-021-06943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/12/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Vagus nerve stimulator (VNS) implantation is an established therapy for pharmacoresistant epilepsy that is not amenable to curative epilepsy surgery. Historically, VNS implantation has been performed by neurosurgeons, but otolaryngologist involvement is increasingly common. In this retrospective study, we aimed to evaluate the efficacy and safety of VNS implantation in children and adolescents from the otolaryngologists' perspective. METHODS This study included children and adolescents who had undergone VNS implantation at the study center between 2014 and 2018. Patient files were analyzed with regards to the durations of device implantation and hospitalization, postoperative complications, and clinical outcome, including seizure frequency, clinical global impression of improvement (CGI-I) score, and quality of life (QoL). RESULTS A total of 73 children underwent VNS surgery. The median age at implantation was 9.3 ± 4.6 years, and median epilepsy duration before VNS surgery was 6 ± 4 years. Lennox-Gastaut syndrome was the most common syndrome diagnosis (62.3%), and structural abnormalities (49.3%) the most frequent etiology. Operation times ranged from 30 to 200 min, and median postoperative hospitalization length was 2 ± 0.9 days. No complications occurred, except for four revisions and two explantations due to local infections (2.7%). Among our patients, 76.7% were responders (≥ 50% reduction in seizure frequency), 72.1% showed improved CGI-I scores, and 18.6-60.5% exhibited considerable improvements in the QoL categories energy, emotional health, and cognitive functions. CONCLUSION Our results indicate that VNS implantation is a highly effective and safe treatment option for children and adolescents with AED-refractory epilepsies who are not candidates for curative epilepsy surgery.
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Saibene AM, Fuccillo E, Felisati G. Vagus nerve stimulator implantation for drug-resistant epilepsy, with video. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:69-70. [PMID: 34127409 DOI: 10.1016/j.anorl.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A M Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, via Antonio di Rudinì, 20142 Milan, Italy.
| | - E Fuccillo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, via Antonio di Rudinì, 20142 Milan, Italy.
| | - G Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, via Antonio di Rudinì, 20142 Milan, Italy.
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Raspin C, Shankar R, Barion F, Pollit V, Murphy J, Sawyer L, Danielson V. An economic evaluation of vagus nerve stimulation as an adjunctive treatment to anti-seizure medications for the treatment of drug-resistant epilepsy in England. J Med Econ 2021; 24:1037-1051. [PMID: 34348576 DOI: 10.1080/13696998.2021.1964306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Anti-seizure medications (ASMs) are commonly used to prevent recurring epileptic seizures, but around a third of people with epilepsy fail to achieve an adequate response. Vagus nerve stimulation (VNS) is clinically recommended for people with drug-resistant epilepsy (DRE) who are not suitable for surgery, but the cost-effectiveness of the intervention has not recently been evaluated. The study objective is to estimate costs and quality-adjusted life-years (QALYs) associated with using VNS as an adjunct to ongoing ASM therapy, compared to the strategy of using only ASMs in the treatment of people with DRE, from an English National Health Service perspective. METHODS A cohort state transition model was developed in Microsoft Excel to simulate costs and QALYs of the VNS + ASM and ASM only strategies. Patients could transition between five health states, using a 3-month cycle length. Health states were defined by an expected percentage reduction in seizure frequency, derived from randomized control trial data. Costs included the VNS device as well as its installation, setup, and removal; ASM therapy; adverse events associated with VNS (dyspnea, hoarseness, and cough); and health-state costs associated with epilepsy including hospitalizations, emergency department visits, neurologist visits, and primary care visits. A range of sensitivity analyses, including probabilistic sensitivity analysis, were run to assess the impact of parameter and structural uncertainty. RESULTS In the base case, VNS + ASM had an estimated incremental cost-effectiveness ratio (ICER) of £17,771 per QALY gained compared to ASMs alone. The cost-effective ICER was driven by relative reductions in expected seizure frequency and the differences in health care resource use associated therewith. Sensitivity analyses found that the amount of resource use per epilepsy-related health state was a key driver of the cost component. CONCLUSIONS VNS is expected to be a cost-effective intervention in the treatment of DRE in the English National Health Service.
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Affiliation(s)
| | - Rohit Shankar
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
- Cornwall Partnership NHS Foundation Trust, Bodmin, UK
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Salvage therapy for vagal nerve stimulator infection; Literature review and report of a delayed recurrence. Clin Neurol Neurosurg 2020; 200:106333. [PMID: 33203592 DOI: 10.1016/j.clineuro.2020.106333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/08/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vagal Nerve Stimulation (VNS) is one of the most common neuro-modulation based approaches for the treatment of medically intractable epilepsy. Despite advances in technology and surgical techniques, hardware infection remains a recognized and feared complication in VNS placement. Management of such infections is scarce in the literature with the majority of data available in case reports. It ranges from immediate removal of the VNS device to conservative treatment with antibiotics in an attempt to salvage the device, particularly in patients who demonstrated significant improvement in seizure frequency and quality of life. METHODS We performed a review of the literature in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify reported cases of salvaged VNS infection. A literature search for relevant English articles was conducted using Medline. References of relevant articles were also reviewed. Articles that comprised an attempt to salvage an infected VNS were included. RESULTS We obtained 12 articles describing an attempt to salvage an infected VNS. Out of a total of 62 reported VNS infections and 43 salvage attempts using a variety of antibiotic-based approaches, 17 cases were successfully salvaged and 26 cases failed the salvage attempt and had to be explanted eventually. Moreover, we report a case of an 18-year-old male with Lennox-Gastaut syndrome who presented21 days after VNS placement with a MRSA deep tissue infection. An attempt was made to treat the infection with long-term culture-based intravenous antibiotics, but it recurred three years later with neck wound dehiscence and positive wound culture for the same organism, and ex-plantation was thus performed. CONCLUSION The management of VNS infections remains a dilemma for neurosurgeons. Although the idea of salvaging an infected VNS seems appealing, hardware removal seems to be inevitable despite adequate antibiotic treatment.
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Vocal Outcomes in Vagus Nerve Stimulation: A Laryngeal Pattern-Based Objective Analysis. J Voice 2020; 36:719-725. [DOI: 10.1016/j.jvoice.2020.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
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Kuroda N, Fujimoto A, Okanishi T, Sato K, Itamura S, Baba S, Nishimura M, Ichikawa N, Enoki H. Low Body Mass Index and Low Intelligence Quotient Are Infection Risk Factors in Vagus Nerve Stimulation. World Neurosurg 2019; 130:e839-e845. [PMID: 31295613 DOI: 10.1016/j.wneu.2019.06.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Risk factors for infection after vagus nerve stimulation (VNS) device implantation represent an important issue but remain unclear. We hypothesized that specific risk factors for infection would be associated with VNS device implantation. This study reviewed patients with epilepsy who underwent VNS device implantation and undertook a statistical analysis of risk factors for surgical site infection (SSI). METHODS We reviewed all medical records for patients who underwent VNS therapy in our facility between August 2011 and May 2018. Age, sex, height, body weight, body mass index (BMI), intelligence quotient (IQ), surgical incision opening time, blood loss, epilepsy classification, activities of daily living, and generator replacement were statistically compared between cases with and without SSI. RESULTS We performed 208 VNS device implantation surgeries at our facility during the study period. Among these, 150 patients underwent initial implantation, 56 patients underwent first generator replacement, and 2 patients underwent second replacement. Six patients (2.7%) with initial implantation and 3 patients (5.4%) with first replacement showed SSI. Low BMI was a risk factor for infection at initial implantation (P < 0.0012) using a BMI within 1.78 kg/m2 of the cutoff for being underweight (100% sensitivity, 25% specificity). Low IQ (P = 0.0015) was also a risk factor for SSI. CONCLUSIONS This study identified low BMI and low IQ at initial implantation as risk factors for infection.
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Affiliation(s)
- Naoto Kuroda
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Shinji Itamura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Mitsuyo Nishimura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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Selner AN, Rosinski CL, Chiu RG, Rosenberg D, Chaker AN, Drammeh H, Esfahani DR, Mehta AI. Vagal Nerve Stimulation for Epilepsy in Adults: A Database Risk Analysis and Review of the Literature. World Neurosurg 2019; 121:e947-e953. [DOI: 10.1016/j.wneu.2018.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
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Gigliotti MJ, Mao G, Dupré DA, Wilberger J. Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy. World Neurosurg 2018; 120:e1047-e1053. [DOI: 10.1016/j.wneu.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/26/2022]
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Levine YA, Simon J, Faltys M, Zitnik R. Bioelectronic Therapy for the Treatment of Rheumatoid Arthritis and Inflammatory Bowel Disease. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Musteata M, Mocanu D, Stanciu GD, Armasu M, Solcan G. Interictal cardiac autonomic nervous system disturbances in dogs with idiopathic epilepsy. Vet J 2017; 228:41-45. [PMID: 29153107 DOI: 10.1016/j.tvjl.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
Autonomic nervous system (ANS) activity in the interictal period (InIp) in dogs with presumed idiopathic epilepsy (pIE) was assessed using heart rate variability (HRV) analysis. The HRVs obtained from 28 pIE dogs with interictal epileptic discharges (InIEd; 11 with treatment and 17 without treatment) detected on electroencephalography (EEG) were compared with those obtained from 13 healthy dogs. On electrocardiographic (ECG) study, the P wave dispersion (PWD; P<0.001), P max (P=0.004) and corrected QT interval (QTc; P=0.025) were significantly increased in the pIE group. On the basis of HRV analysis, the pIE dogs had an increased activity of the parasympathetic component of the ANS, including the percentage of R-R interval (pNN50%) that differs more than 50ms (P=0.011) and high frequency band (HF; P=0.041). Administration of phenobarbitone had no influence on the ANS pattern when pIE subgroups were compared (P>0.05). In InIp, dogs elicited specific conductibility delays of the electrical impulses (increased PWD and QTc interval); these delays are considered to be risk factors for developing severe arrhythmias, such as atrial fibrillation and ventricular tachycardia. When compared with human beings, a different ANS pattern characterised by increased parasympathetic activity was observed, which may influence the therapeutic approach of IE in dogs.
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Affiliation(s)
- M Musteata
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - D Mocanu
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - G D Stanciu
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - M Armasu
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - G Solcan
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania.
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Timarova G, Šteňo A. Late-onset jaw and teeth pain mimicking trigeminal neuralgia associated with chronic vagal nerve stimulation: case series and review of the literature. BMC Neurol 2017; 17:113. [PMID: 28619068 PMCID: PMC5473002 DOI: 10.1186/s12883-017-0892-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/06/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Vagal nerve stimulation (VNS) for refractory epilepsy is well established. Trigeminal neuralgia itself is a common disease in adults, and thus, late-onset pain in the trigeminal region under VNS, which is extremely rare, may not be recognized as caused by VNS. CASE PRESENTATION Two patients with drug-resistant symptomatic epilepsy treated with chronic VNS experienced stimulation-related pain in the lower and upper jaw and teeth on the side of stimulation. No evidence of local spread of the stimulation current was present. The pain started with a delay of years after device implantation and weeks after the last increase in the pacing parameters. At the time of onset, the pain was not recognized as VNS-related, leading to extensive examinations. The trigeminal neuralgia-like pain resolved after adjustment of the stimulation current intensity. In one of the patients, the pain disappeared within one to two days following every epileptic seizure. To our knowledge, this is the first case report of late-onset trigeminal pain under VNS revealing a direct link between epileptogenic and pain processes. CONCLUSION A painless interval between the last change of the pacing parameters and trigeminal pain can lead to the erroneous interpretation that this is a typical trigeminal neuralgia. The lack of its recognition as a side effect of VNS can lead to unnecessary examinations and delayed adjustment of stimulation parameters. In patients with signs of late-onset trigeminal pain under VNS with normal electrode impedance and no evidence of local current spread, the replacement of the VNS lead does not seem to be beneficial. A review of the literature on VNS side effects including pain and device malfunctions was undertaken.
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Affiliation(s)
- Gabriela Timarova
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Dérer's University Hospital, Limbova str.5, 83305, Bratislava, Slovak Republic.
| | - Andrej Šteňo
- Department of Neurosurgery, Faculty of Medicine, Comenius University, Dérer's University Hospital, Bratislava, Slovak Republic
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Giordano F, Zicca A, Barba C, Guerrini R, Genitori L. Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity. Epilepsia 2017; 58 Suppl 1:85-90. [DOI: 10.1111/epi.13678] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Anna Zicca
- Department of Neuroanaesthesiology; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Carmen Barba
- Pediatric Neurology Unit; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Lorenzo Genitori
- Department of Neurosurgery; Anna Meyer Hospital; University of Firenze; Firenze Italy
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Millington A, Farboud A, Buchanan M, Bath A. Vagus nerve stimulator implantation: a UK Otolaryngology Department's 9-year experience of implanting fifty six patients. Clin Otolaryngol 2017; 42:188-192. [DOI: 10.1111/coa.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - A. Farboud
- Norfolk and Norwich University Hospital; Norwich Norfolk UK
| | - M.A. Buchanan
- Norfolk and Norwich University Hospital; Norwich Norfolk UK
| | - A.P. Bath
- Norfolk and Norwich University Hospital; Norwich Norfolk UK
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Lam S, Lin Y, Curry DJ, Reddy GD, Warnke PC. Revision surgeries following vagus nerve stimulator implantation. J Clin Neurosci 2016; 30:83-87. [DOI: 10.1016/j.jocn.2016.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Complications of vagal nerve stimulation for drug-resistant epilepsy: a single center longitudinal study of 143 patients. Seizure 2013; 22:827-33. [PMID: 23867218 DOI: 10.1016/j.seizure.2013.06.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To longitudinally study surgical and hardware complications to vagal nerve stimulation (VNS) treatment in patients with drug-resistant epilepsy. METHODS In a longitudinal retrospective study, we analyzed surgical and hardware complications in 143 patients (81 men and 62 women) who between 1994 and 2010 underwent implantation of a VNS-device for drug-resistant epilepsy. The mean follow-up time was 62 ± 46 months and the total number of patient years 738. RESULTS 251 procedures were performed on 143 patients. 16.8% of the patients were afflicted by complications related to surgery and 16.8% suffered from hardware malfunctions. Surgical complications were: superficial infection in 3.5%, deep infection needing explantation in 3.5%, vocal cord palsy in 5.6%, which persisted in at least 0.7% for over one year, and other complications in 5.6%. Hardware-related complications were: lead fracture in 11.9% of patients, disconnection in 2.8%, spontaneous turn-off in 1.4% and stimulator malfunction in 1.4%. We noted a tendency to different survival times between the two most commonly used lead models as well as a tendency to increased infection rate with increasing number of stimulator replacements. CONCLUSION In this series we report on surgical and hardware complications from our 16 years of experience with VNS treatment. Infection following insertion of the VNS device and vocal cord palsy due to damage to the vagus nerve are the most serious complications related to the surgery. Avoiding unnecessary reoperations in order to reduce the appearances of these complications are of great importance. It is therefore essential to minimize technical malfunctions that will lead to additional surgery. Further studies are needed to evaluate the possible superiority of the modified leads.
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