Vagus nerve stimulation for the management of seizures in children: an 8-year experience

Coykendall, David S.; Gauderer, Michael W.L.; Blouin, Randall R.; Morales, Augusto

doi:10.1016/j.jpedsurg.2010.02.066

Cited by 43 publications

(21 citation statements)

References 20 publications

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“…Most previous studies present frequencies ranging from 2.5% to 12.5%. 2,11,15,18,22,23,34,38,39 It is reasonable to believe that the complication frequency increases with a longer follow-up time, considering the repeated surgeries needed due to depleted batteries and hardware being worn out. Kahlow and Olivecrona 21 recently presented a single-center longitudinal study of 143 patients with a mean follow-up time of 62 months.…”

Section: Discussionmentioning

confidence: 99%

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Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Révész

Rydenhag

Ben‐Menachem

2016

PED

134

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OBJECTIVE The goal of this paper was to investigate surgical and hardware complications in a longitudinal retrospective study. METHODS The authors of this registry study analyzed the surgical and hardware complications in 247 patients who underwent the implantation of a vagus nerve stimulation (VNS) device between 1990 and 2014. The mean follow-up time was 12 years. RESULTS In total, 497 procedures were performed for 247 primary VNS implantations. Complications related to surgery occurred in 8.6% of all implantation procedures that were performed. The respective rate for hardware complications was 3.7%. Surgical complications included postoperative hematoma in 1.9%, infection in 2.6%, vocal cord palsy in 1.4%, lower facial weakness in 0.2%, pain and sensory-related complications in 1.4%, aseptic reaction in 0.2%, cable discomfort in 0.2%, surgical cable break in 0.2%, oversized stimulator pocket in 0.2%, and battery displacement in 0.2% of patients. Hardware-related complications included lead fracture/malfunction in 3.0%, spontaneous VNS turn-on in 0.2%, and lead disconnection in 0.2% of patients. CONCLUSIONS VNS implantation is a relatively safe procedure, but it still involves certain risks. The most common complications are postoperative hematoma, infection, and vocal cord palsy. Although their occurrence rates are rather low at about 2%, these complications may cause major suffering and even be life threatening. To reduce complications, it is important to have a long-term perspective. The 25 years of follow-up of this study is of great strength considering that VNS can be a life-long treatment for many patients. Thus, it is important to include repeated surgeries such as battery and lead replacements, given that complications also may occur with these surgeries.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies report 0.5% to 20.8%. 11,15,20,21,24,27,34,37,38 Of the 13 lead malfunctions, all but 1 was of the Cyberonics model 300, which suggests that this model is more susceptible to breakage. This product is no longer distributed by Cyberonics, and lead failure has decreased significantly since the introduction of newer models.…”

Section: 42mentioning

confidence: 99%

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Révész

Rydenhag

Ben‐Menachem

2016

PED

134

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“…Vagus nerve stimulation can be efficacious even in very young patients. 6,9,17 However, consideration should be made for the possibility of nerve traction by placing redundancy with anchoring in the lead in anticipation of the child's growth. Traction of the vagus nerve by a tethered lead can cause intractable bradycardia, and termination of VNS therapy is the first option in such cases.…”

Section: Discussionmentioning

confidence: 99%

Intractable episodic bradycardia resulting from progressive lead traction in an epileptic child with a vagus nerve stimulator: a delayed complication

Clark

Kuperman²,

Auguste

et al. 2012

PED

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Vagus nerve stimulation (VNS) is used as palliation for adult and pediatric patients with intractable epilepsy who are not candidates for curative resection. Although the treatment is generally safe, complications can occur intraoperatively, perioperatively, and in a delayed time frame. In the literature, there are 2 reports of pediatric patients with implanted VNS units who had refractory bradycardia that resolved after the stimulation was turned off. The authors report the case of a 13-year-old boy with a history of vagus nerve stimulator placement at 2 years of age, who developed intractable episodic bradycardia that persisted despite the cessation of VNS and whose imaging results suggested vagus nerve tethering by the leads. He was subsequently taken to the operating room for exploration, where it was confirmed that the stimulator lead was exerting traction on the vagus nerve, which was displaced from the carotid sheath. After the vagus nerve was untethered and the leads were replaced, the bradycardia eventually resolved with continual effective VNS therapy. When placing a VNS unit in a very young child, accommodations must be made for years of expected growth. Delayed intractable bradycardia can result from a vagus nerve under traction by tethered stimulator leads.

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“…Optimal stimulation parameters, interval between each programming and the high limits of stimulation have yet to be determined (McLachlan, 2001). The efficacy and safety of vagus nerve stimulation has been studied in several patients, including adults and children with refractory epilepsies, with satisfactory results even in small children (Alexopoulos et al, 2006;Benifla et al, 2006;García-March et al, 2008;Elliot et al, 2009;Coykendall et al, 2010;Elliot et al, 2011). It may be indicated in patients with focal or generalized epilepsies and when associated with other methods including antiepileptic drugs, ketogenic diet and resective surgeries approximately 60% of the patients experienced at least 50% reduction in seizure frequency (Elliot et al, 2011).…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Epilepsy Surgery in Children

Sakamoto¹,

Machado²

2011

Epilepsy in Children - Clinical and Social Aspects

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Vagus nerve stimulation for the management of seizures in children: an 8-year experience

Cited by 43 publications

References 20 publications

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Intractable episodic bradycardia resulting from progressive lead traction in an epileptic child with a vagus nerve stimulator: a delayed complication

Epilepsy Surgery in Children

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