Vagal Nerve Stimulator Therapy: An Unusual Cause of Symptomatic Bradycardia

Jyothidasan, Amudhan; Garg, Ashok; Nagabandi, Arun; Sorrentino, Robert

doi:10.1016/s0735-1097(17)35712-1

Cited by 1 publication

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“…hoarseness, dysphonia) due to the vagus nerve’s effect on vocal cord motion and supraglottic muscle tension [ 16 ]. Other side effects include bradyarrhythmias (from parasympathetic stimulation of the atrioventricular node) [ 9 ], cardiac syncope and asystole [ 17 ], respiratory problems (cough, dyspnea, sleep disordered breathing) [ 18 , 19 ], surgical or hardware complications (infection, lead malfunction, vocal cord palsy) [ 20 ], Horner syndrome [ 21 ], and dysphagia and/or aspiration [ 22 ]. However, intractable singultus has not previously been recognized as a potential VNS complication to the best knowledge of the authors.…”

Section: Discussionmentioning

confidence: 99%

Intractable hiccups after VNS implantation: a case report

Recio,

Abdennadher

2023

BMC Neurol

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Background Hiccups (medically termed, “singultus”), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy. Case presentation We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient’s hiccups persisted and only stopped once the VNS was permanently deactivated. Conclusions Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.

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