Vagus nerve stimulation in children with refractory epilepsy: unusual complications and relationship to sleep-disordered breathing

Khurana, Divya S.; Reumann, Marko; Hobdell, Elizabeth F.; Neff, Samuel; Valencia, Ignacio; Legido, Agustín; Kothare, Sanjeev V.

doi:10.1007/s00381-007-0404-8

Cited by 72 publications

(55 citation statements)

References 16 publications

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“…31 Khurana et al reported that tonsillectomy and adenoidectomy reduced seizure frequency by ≥ 50% in children with mild to moderate OSA after placement of a VNS. 17 Presumably reducing the number of apneas and hypopneas improved seizure control in this small group of patients. 17 In addition, a major treatment issue in these patients is CPAP compliance, especially in the pediatric population.…”

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 87%

“…17 Presumably reducing the number of apneas and hypopneas improved seizure control in this small group of patients. 17 In addition, a major treatment issue in these patients is CPAP compliance, especially in the pediatric population. More prospective studies involving a larger number of patients are needed to determine whether VNS-induced apnea influences seizure control and/or quality of life in patients with epilepsy.…”

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 87%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In these studies, the number of patients included ranged from 1 to 60. Of these 15 articles, 4 involved only pediatric patients, 8,12,13,17 7 involved only adult patients, 4,5,10,11,[14][15][16] and 4 studies involved both adult and pediatric patients. 3,6,7,9 The patient ages ranged from 3 to70 years.…”

Section: Methodsmentioning

confidence: 99%

“…Eight case reports and small case series totaling 36 patients (Table 3) [4][5][6][7]10,[14][15][16][17] show that VNS increases the AHI, which usually improves after discontinuation of the VNS. Marzec et al studied 16 adult patients with VNS to determine if there was a change in AHI and oxygen saturation during sleep with VNS activation.…”

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 99%

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Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

115

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Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fi bers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation. (VNS) to control refractory epilepsy in 1990. 1 Intermittent vagus nerve stimulation can reduce seizures by up to 50% in adult seizure patients and up to 90% in pediatric seizure patients. The FDA approved these devices for the treatment of refractory epilepsy in 1997 and for the treatment of refractory depression in 2005. VNS are currently under investigation for treatment of anxiety, obesity, bulimia, migraines, Alzheimer disease, chronic pain syndromes, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. 2 Vagus nerve stimulation can cause side effects involving the upper airway, lower respiratory tract, and upper gastrointestinal tract. These devices can decrease airfl ow, oxygen saturation, and respiratory amplitude during sleep. 3 Most patients with VNS have an increase in their apnea-hypopnea index (AHI) after implantation. 4 One-third of these patients develop mild obstructive sleep apnea post treatment, 4,5 and a minority of patients develop severe obstructive sleep apnea secondary to VNS therapy. 6 More than 50,000 patients have had VNS implants to date, and it is important for sleep medicine specialists to recognize the sleep disordered breathing and other respiratory complications related to VNS devices. We recently helped care for a patient who developed obstructive sleep apnea (OSA) after implantation of a VNS and then required discontinuation of the VNS. Our review of literature while attempting to answer some clinically relevant questions pertaining to this patient led to this review. This article focuses on six questions pertinent to the management of these patients and reviews the literature on sleep-related and respiratory complications associated with vagus nerve stimulators. mETHODSWe conducted a literature search with ...

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Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 87%

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 99%

See 2 more Smart Citations

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

115

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show abstract

“…Decreases in airflow and respiratory effort (and rarely, frank obstructive events) are observed during the 30-second period when the stimulator activates (typically every 5 minutes). These findings have been Primary Sleep Disorders in People with Epilepsy observed in adults [88][89][90] and children 66,68,[91][92][93][94][95] treated with the device. Most often, the respiratory change is an increase in the respiratory rate and decrease in respiratory amplitude when the device fires, which usually does not cause an arousal or desaturation.…”

Section: Recognizing the Effects Of Vagal Nerve Stimulation On Respirmentioning

confidence: 82%

Primary Sleep Disorders in People with Epilepsy

Grigg-Damberger

Foldvary‐Schaefer

2015

Child and Adolescent Psychiatric Clinics of North America

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2010

Neuropsychological Assessment and Intervention for Childhood and Adolescent Disorders

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Vagus nerve stimulation in children with refractory epilepsy: unusual complications and relationship to sleep-disordered breathing

Cited by 72 publications

References 16 publications

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Primary Sleep Disorders in People with Epilepsy

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