Complications of vagal nerve stimulation for epilepsy in children

Rychlicki, F.; Zamponi, Nelia; Cesaroni, Elisabetta; Corpaci, Ludovica; Trignani, Roberto; Ducati, Alessandro; Scerrati, Massimo

doi:10.1007/s10143-005-0005-5

Cited by 65 publications

(70 citation statements)

References 27 publications

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“…Typically, these symptoms abate with time or alteration of the stimulation parameters. 2,3,19,36,44,50 Significant or permanent injuries to the vagus nerve or development of dysphagia following implantation were rare (< 0.5%) in our series, and the rate is comparable to rates reported for other series (≤ 4%). The rate of infection was under 3%, which is comparable to rates reported in most large series (0%-8%) and similar to those reported for other implantable devices.…”

Section: Complications and Cosmetic Considerationssupporting

confidence: 85%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

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Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1–18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days–11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children.

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Section: Complications and Cosmetic Considerationssupporting

confidence: 85%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

View full text Add to dashboard Cite

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“…Other authors have noted complications after lead revision including transient vocal cord paralysis. 17 There were no infections postoperatively and therefore no increase in the postoperative infection rate as compared with historical averages.…”

Section: Discussionmentioning

confidence: 78%

“…6 Given the increasing use of VNS for the treatment of medically intractable epilepsy, however, VNS lead failure is more commonly observed. 1,8,12,[15][16][17]19,20 The determination of lead failure relies on multiple factors, including the patient's clinical symptoms, seizure frequency, and interrogation of the system and lead impedance. We found that lead failure occurs for a variety of reasons and in our series was most commonly observed in cases of high impedance within the VNS lead, which was found in 72% of our lead revisions ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…20 Additionally, dislocated leads, 20 hardware-related infection, 2 device malfunction, and short circuits within the system were noted. 20 Imaging of the neck and chest with radiography can often be used to diagnose visible fractures 17 and dislocated lead coils. 20 It is unclear at this time if there are any risk factors that may predispose someone to a specific type of lead failure.…”

Section: Discussionmentioning

confidence: 99%

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Vagus nerve stimulation after lead revision

Dlouhy¹,

Viljoen²,

Kung³

et al. 2012

FOC

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Object Vagus nerve stimulation (VNS) has demonstrated benefit in patients with medically intractable partial epilepsy. As in other therapies with mechanical devices, hardware failure occurs, most notably within the VNS lead, requiring replacement. However, the spiral-designed lead electrodes wrapped around the vagus nerve are often encased in dense scar tissue hampering dissection and removal. The objective in this study was to characterize VNS lead failure and lead revision surgery and to examine VNS efficacy after placement of a new electrode on the previously used segment of vagus nerve. Methods The authors reviewed all VNS lead revisions performed between October 2001 and August 2011 at the University of Iowa Hospitals and Clinics. Twenty-four patients underwent 25 lead revisions. In all cases, the helical electrodes were removed, and a new lead was placed on the previously used segment of vagus nerve. All inpatient and outpatient records of the 25 lead revisions were retrospectively reviewed. Results Four cases were second lead revisions, and 21 cases were first lead revisions. The average time to any revision was 5 years (range 1.8–11.1 years), with essentially no difference between a first and second lead revision. The most common reason for a revision was intrinsic lead failure resulting in high impedance (64%), and the most common symptom was increased seizure frequency (72%). The average duration of surgery for the initial implantation in the 15 patients whose VNS system was initially implanted at the authors' institution was much shorter (94 minutes) than the average duration of lead revision surgery (173 minutes). However, there was a significant trend toward shorter surgical times as more revision surgeries were performed. Sixteen of the 25 cases of lead revision were followed up for more than 3 months. In 15 of these 16 cases, the revision was as effective as the previous VNS lead. In most of these cases, both the severity and frequency of seizures were decreased to levels similar to those following the previous implantation procedure. Only 1 complication occurred, and there were no postoperative infections. Conclusions Lead revision surgery involving the placement of a new electrode at the previously used segment of vagus nerve is effective at decreasing the seizure burden to an extent similar to that obtained following the initial VNS implantation. Even with multiple lead revisions, patients can obtain VNS efficacy similar to that following the initial lead implantation. There is a learning curve with revision surgery, and overall the duration of surgery is longer than for the initial implantation. Note, however, that complications and infection are rare.

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“…There have been complications reported either due to the surgical procedure as such or due to hardware-related problems. 6,8,14,16 Side effects are mainly related to stimulation, are usually reversible, and tend to decrease over time. They seldom necessitate the removal of the device.…”

Section: 15mentioning

confidence: 99%

The “vagal ansa”: a source of complication in vagus nerve stimulation

Gopalakrishnan

Kestle

Connolly

2015

PED

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A 16-year-old boy underwent vagus nerve stimulation for treatment-resistant multifocal epilepsy. During intraoperative system diagnostics, vigorous contraction of the ipsilateral sternomastoid muscle was observed. On re-exploration, a thin nerve fiber passing from the vagus to the sternomastoid was found hooked up in the upper electrode. Detailed inspection revealed an abnormal course of the superior root of the ansa cervicalis, which descended down as a single nerve trunk with the vagus and separated to join the inferior root. The authors discuss the variation in the course of the ansa cervicalis and how this could be a reason for postoperative neck muscle contractions.

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Complications of vagal nerve stimulation for epilepsy in children

Cited by 65 publications

References 27 publications

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus nerve stimulation after lead revision

The “vagal ansa”: a source of complication in vagus nerve stimulation

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