Lead revision surgery for vagus nerve stimulation in epilepsy: Outcomes and efficacy

Waseem, Hena; Raffa, Scott J.; Benbadis, Selim R.; Vale, Fernando Ĺ.

doi:10.1016/j.yebeh.2013.12.002

Cited by 17 publications

(7 citation statements)

References 23 publications

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“…These observations might be related to the anatomy of the CVN in the carotid sheath and to the branching patterns to the effect that stimulation of CVN branches results in insufficient therapeutic effect. Surgery-related side effects such as voice alterations, dyspnea [ 6 , 9 ], vocal cord palsy [ 16 ], coughing, neck and throat pain [ 6 ] are found in 17% of the patients that undergo VNS [ 16 , 54 ]. Some of these complications may probably be attributed to branches of the vagus nerve, especially the superior and to the (non-) recurrent inferior laryngeal nerve.…”

Section: Discussionmentioning

confidence: 99%

Human Vagus Nerve Branching in the Cervical Region

et al. 2015

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BackgroundVagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation.Materials and MethodsBranching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections.ResultsCervical vagus nerve branching was observed in 29% of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79 mm vs. 3.78 mm) and cross-sections (7.24 mm2 vs. 5.28 mm2).DiscussionCervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.

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Section: Discussionmentioning

confidence: 99%

Human Vagus Nerve Branching in the Cervical Region

et al. 2015

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“…Tatum et al 8 reported two-thirds of epilepsy patients had similar changes in symptoms heralding estimated end of service. Waseem et al 9 reported VNS device failure from broken leads most commonly increased seizure frequency. Eight of 10 seizure patients undergoing lead revisions because of device failure felt a return of their response similar to that before lead failure.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive vagus nerve stimulation for treatment-resistant bipolar disorder: managing device failure or the end of battery life

Pardo¹

2016

BMJ Case Reports

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The vagus nerve stimulation (VNS) device is used not only to treat refractory seizure disorders but also mood disorders; the latter indication received CE Mark approval in 2001 and Food and Drug Administration approval in 2005. Original estimates for the end of battery life (EOBL) were approximately 6-10 years. Many neuropsychiatric patients have or will soon face EOBL. A patient with severe, life-threatening, treatment-resistant bipolar disorder underwent 9 years of stable remission following 20 months of adjunctive VNS. The device ceased operation at EOBL. Because of logistical issues, re-initiation of VNS was delayed over several months. The patient relapsed with depression, mania and mixed states, and regained remission 17 months after device replacement. This case dictates prudence in managing stable patients in remission with VNS. If the device malfunctions, urgent surgical replacement is warranted with subsequent rapid titration to previous parameters as tolerated. Several months' delay may trigger relapse and prove difficult to re-establish remission.

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“…We identified seven studies [ 1 , 9 , 11 , 17 – 19 , 30 ] and five case reports [ 12 , 23 , 27 – 29 ] focusing on lead removal or replacement. Additionally, nine studies described lead removal or replacement as part of a broader report on VNS treatment [ 2 , 6 , 10 , 14 , 16 , 22 , 24 , 25 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Finally, with regard to the efficacy of a replaced VNS system, Dlouhy et al reported that the replaced VNS system was as effective as the initial one in 15 out of 16 cases they had operated [ 9 ]. Waseem et al reported that nine out of ten patients reported an equal or improved clinical response compared with their initial VNS system, and none of them reported a worse quality of life [ 30 ]. The number of anti-epileptic drugs was unaltered in the vast majority of patients [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview

et al. 2015

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BackgroundWith the growing use of vagus nerve stimulation (VNS) as a treatment for refractory epilepsy, there is a growing demand for complete removal or replacement of the VNS system. We evaluate the safety and efficacy of complete removal or replacement of the VNS system and provide an extensive description of our surgical technique.MethodsWe retrospectively reviewed our patient registry for all VNS surgeries performed between January 2007 (the year of our first complete removal) and May 2014. In order to assess patient satisfaction, a written questionnaire was sent to patients or their caregivers. Additionally, we reviewed all literature on this topic.ResultsThe VNS system was completely removed in 22 patients and completely replaced in 13 patients. There were no incomplete removals. Revision surgery was complicated by a small laceration of the jugular vein in two patients and by vocal cord paralysis in one patient. Seizure frequency was unaltered or improved after revision surgery. Electrode-related side effects all improved after revision surgery. Twenty-one studies reported a total of 131 patients in whom the VNS system was completely removed. In 95 patients, the system was subsequently replaced. The most frequently reported side effect was vocal cord paresis, which occurred in four patients.ConclusionsComplete removal or replacement of the VNS system including lead and coils is feasible and safe. Although initial results seem promising, further research and longer follow-up are needed to assess whether lead replacement may affect VNS effectiveness.Electronic supplementary materialThe online version of this article (doi:10.1007/s00701-015-2547-9) contains supplementary material, which is available to authorized users.

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Lead revision surgery for vagus nerve stimulation in epilepsy: Outcomes and efficacy

Cited by 17 publications

References 23 publications

Human Vagus Nerve Branching in the Cervical Region

Human Vagus Nerve Branching in the Cervical Region

Adjunctive vagus nerve stimulation for treatment-resistant bipolar disorder: managing device failure or the end of battery life

Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview

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