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Complications of vagal nerve stimulation for epilepsy in children

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Abstract

Vagal nerve stimulation (VNS) is a surgical option to treat drug-resistant epilepsy. A few side effects have been described, mainly as anecdotal reports. We analysed our material concerning a juvenile population to identify the most common and most important complications, discussing them with the literature. Thirty-six patients were studied (18 months–18 years old). The children were assessed before the VNS implant and 3, 6, 12, 24 and 36 months after surgery. The mean follow-up was 30 months. Four patients required a second surgery: two for changing the device 3 years after implant; one for revision of an imperfect implant; one for removing a non-functioning device. In one patient a transient vocal cord paralysis was observed. Hoarseness was the main complaint (38.8%). More infrequent was mild sleep apnoea (8.3%), sternocleidomastoid muscle spasm, drooling and snoring in one patient each. Skin scars were reported with a different frequency according to the surgical technique. At variance with the literature reports, we did not observe infections. Side effects of VNS can be minimised, but not avoided completely, with a correct technical procedure, which in turn depends upon a thorough knowledge of vagus nerve anatomy.

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References

  1. Aldenkamp AP, Van de Veerdonk HA et al (2001) Effects of 6 months of treatment with vagus nerve stimulation on behaviour in children with Lennox Gastaut Syndrome in an open clinical and nonrandomized study. Epilepsy Behav 2:343–350

    Article  PubMed  Google Scholar 

  2. Annegers JF, Coan SP, Hause WA, Leestma J, Duffel W, Tarver B (1998) Epilepsy, vagal nerve stimulation by NCP system, mortality and sudden, unexpected,unexplained death. Epilepsia 39:206–212

    Article  PubMed  CAS  Google Scholar 

  3. Asconapé J, Moore, Zipes D, Hartmann L, Duffel WH (1999) Bradycardia and asystole with the use of vagus nerve stimulation the treatment of epilepsy: a rare complication of intraoperative device testing. Epilepsia 40:1452–1454

    Article  PubMed  Google Scholar 

  4. De Giorgio CM, Amar A, Apuzzo MLJ (2001) Surgical anatomy, implantation technique, and operative complications. In: Schmidt D, Schachter SC (ed) Vagus nerve stimulation. Martin Dunitz, London, pp 31–50

  5. Espinosa J, Aiello MT, Naritouku DK (1999) Revision and removal of stimulating electrodes following long term therapy with the vagus nerve stimulator. Surg Neurol 51:659–664

    Article  PubMed  CAS  Google Scholar 

  6. Fisher RS, Krauss GL, Ramsay E et al (1997) Assessment of vagus nerve stimulation in epilepsy: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 49:293–297

    PubMed  CAS  Google Scholar 

  7. Frei MG, Osorio I (2001) Left vagus nerve stimulation with the neurocybernetic prosthesis has complex effexts on heart rate and on its variability in humans. Epilepsia 42:1007–1016

    Article  PubMed  CAS  Google Scholar 

  8. Frost M, Gates J, Helmers SL, Wheless JW et al (2001) Vagus nerve stimulation in children with refractory seizures associated with Lennox Gastaut Syndrome. Epilepsia 42:1148–1152

    Article  PubMed  CAS  Google Scholar 

  9. Glazier SS, O’Donovan A, Bell WL et al (2000) Placement of the vagus nerve stimulator and electrodes through a single transverse cervical incision: experience with 25 patients. Epilepsia 41:221

    Google Scholar 

  10. Handforth A, De Giorgio CM, Schachter SC et al (1998) Vagus nerve stimulation therapy for partial onset seizures. Neurology 51:58–55

    Google Scholar 

  11. Hornig GW, Murphy JV, Schallert G (1997) Left vagal nerve stimulation in children with refractory epilepsy: an update. South Med J 90:485–488

    Google Scholar 

  12. Kersing W, Dejonckere PH,Van der Aa HE, Buschman HPJ (2002) Laryngeal and vocal changes during vagus nerve stimulation in epileptic patients. J Voice 16:251–257

    Article  PubMed  Google Scholar 

  13. Labar D (2000) Vagus nerve stimulation for intractable epilepsy in children. Dev Med Child Neurol 42:496–499

    Article  PubMed  CAS  Google Scholar 

  14. Landy HJ, Ramsay RE, Slater J, Casiano R, Morgan R (1993) Vagus Nerve stimulation for complex partial seizures: surgical technique, safety and efficacy. J Neurosurgery 78:26–31

    CAS  Google Scholar 

  15. Lesser RP (2000) Ventricular asystole during vagus nerve stimulation for epilepsy in humans. Neurology 54:776

    PubMed  CAS  Google Scholar 

  16. Lundgren J, Amark P, Blennow G, Strombald LG (1998) Vagus nerve stimulation in 16 children with refractory epilepsy. Epilepsia 39:809–813

    Article  PubMed  CAS  Google Scholar 

  17. Lundgren J, Ekberg O, Olsson R (1998) Aspiration: a potential complication to vagus nerve stimulation. Epilepsia 39:998–1000

    Article  PubMed  CAS  Google Scholar 

  18. Majoie HJM, Berfelo MW, Aldenkamp AP, Evers SMAA, Kessels AGH, Renier WO (2001) Vagus nerve stimulation in children with therapy–resistant epilepsy diagnosed as Lennox Gastaut Syndrome. Clinical results, neuropsychological effects, and cost effectiveness. J Clin Neurophysiol 18:419–428

    Article  PubMed  CAS  Google Scholar 

  19. Marzec M, Edwards J, Sagher O, Fromes G, Malow BA (2003) Effects of vagus nerve stimulation on sleep-related breathing in epilepsy patients. Epilepsia 44:930–935

    Article  PubMed  Google Scholar 

  20. Murphy JV, Pediatric VNS Study Group (1999) Left vagal nerve stimulation in children with medically refractory epilepsy. J Pediatr 134:563–566

  21. Murphy JV, Hornig GW, Schallert GS, Tilton CL (1998) Adverse events in children receiving intermittent left vagal nerve stimulation. Pediatr Neurol 1:42–44

    Article  Google Scholar 

  22. Nagarajan L, Walsh P, Gregory P, Stick S et al (2003) Respiratory pattern changes in sleep in children on vagal nerve stimulation for refractory epilepsy. Can J Neurol Sci 30:224–227

    PubMed  Google Scholar 

  23. Parker APJ, Polkey CE, Binnie CD et al (1999) Vagal nerve stimulation in epileptic encephalopathies. Pediatrics 103:778–782

    Article  PubMed  CAS  Google Scholar 

  24. Ramsay RE, Uthman BM, Augustinsson LE et al (1994) Vagus nerve stimulation for treatment of partial seizure. 2. Safety, side effects, and tolerability. First International Vagus Nerve Stimulation Group. Epilepsia 35:627–636

    Article  PubMed  CAS  Google Scholar 

  25. Smyth MD, Tubbs RS, Bebin EM, Grabb BA, Blount JP (2003) Complications of chronic vagus nerve stimulation for epilepsy in children. J Neurosurg 99:500–503

    Article  PubMed  Google Scholar 

  26. Vassilyadi M, Strawsburg RH (2003) Delayed onset of vocal cord paralysis after explantation of a vagus nerve stimulator in a child. Childs Nerv Syst 19:261–263

    PubMed  CAS  Google Scholar 

  27. Zalvan C, Sulica L, Wolf S, Cohen J, Gonzalez-Yanes O, Blitzer A (2003) Laryngopharyngeal dysfunction from the implant vagal nerve stimulator. Laryngoscope 113:221–225

    Article  PubMed  Google Scholar 

  28. Zamponi N, Rychlicki F, Cardinali C, Luchetti A, Trignani R, Ducati A (2002) Intermittent vagal nerve stimulation in paediatric patients: 1-year follow-up. Childs Nerv Syst 18:61–66

    Article  PubMed  Google Scholar 

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Rychlicki, F., Zamponi, N., Cesaroni, E. et al. Complications of vagal nerve stimulation for epilepsy in children. Neurosurg Rev 29, 103–107 (2006). https://doi.org/10.1007/s10143-005-0005-5

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  • DOI: https://doi.org/10.1007/s10143-005-0005-5

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