Vagus Nerve Stimulation in the Treatment of Refractory Epilepsy

Milby, Andrew H.; Halpern, Casey H.; Baltuch, Gordon H.

doi:10.1016/j.nurt.2009.01.010

Cited by 50 publications

(42 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The VNS delivers stimulation at set intervals, with adjustable factors, such as stimulation on-time, stimulation off-time, output current, frequency, and pulse width. 18 The generator typically provides a 0.5-millisecond pulse repeated at 10-30 Hz for 30 sec, every 150 to 300 seconds. 2 The current output is incrementally increased by 0.25 mA to 0.5 mA every 2 to 4 weeks according to the patient's response, until the optimum current output for stimulation is attained.…”

Section: Methodsmentioning

confidence: 99%

“…2 The current output is incrementally increased by 0.25 mA to 0.5 mA every 2 to 4 weeks according to the patient's response, until the optimum current output for stimulation is attained. 18 A programming wand that communicates with the generator using radio frequency signals can be used to vary the output current, frequency, pulse width, and stimulation off and on time. 2 Additionally, a 50 gauss bar magnet provided by the manufacturer was reported in 8 studies [4][5][6][7]10,[14][15][16] and oxygen saturation was reported in 6.…”

Section: Methodsmentioning

confidence: 99%

“…Voice alteration is the most common side effect and occurs in 2% to 88% of patients. 18 Other respiratory side effects include coughing (6% to 45%), dyspnea (4% to 25%), and pharyngitis (25% to 35%) ( Tables 1 and 2). Left vocal cord adduction caused by stimulation of the left recurrent laryngeal nerve is likely responsible for the laryngeal and respiratory symptoms that develop in these patients.…”

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 99%

“…Left vocal cord adduction caused by stimulation of the left recurrent laryngeal nerve is likely responsible for the laryngeal and respiratory symptoms that develop in these patients. 18 More than half of the patients with VNS implants have intermittent or permanent vocal cord paresis. 23,18 The left vagus has proportionally fewer cardiac efferent fibers, and placing the stimulator on this side potentially limits the arrhythmogenic effects of vagal stimulation.…”

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 99%

“…18 More than half of the patients with VNS implants have intermittent or permanent vocal cord paresis. 23,18 The left vagus has proportionally fewer cardiac efferent fibers, and placing the stimulator on this side potentially limits the arrhythmogenic effects of vagal stimulation. However, reversible bradyarrhythmias associated with VNS have been described, 2 and patients with can be used either to deliver a burst of vagal stimulation or to inhibit output, depending on whether the magnet is placed transiently or for a prolonged duration over the generator.…”

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 99%

See 4 more Smart Citations

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

View full text Add to dashboard Cite

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 ...

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 99%

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 99%

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 99%

See 3 more Smart Citations

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

View full text Add to dashboard Cite

show abstract

Laryngology Outcomes Following Implantable Vagus Nerve Stimulation

Brauer

Lamarre

Gau

et al. 2023

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

ImportanceVagus nerve stimulation (VNS) devices have gained widespread acceptance for treatment of resistant epilepsy and depression. The increasing number of procedures has resulted in an increasing number of iatrogenic injuries to the vagus nerve, which can have a significant effect on vocalization and quality of life.ObjectiveTo determine the relative frequency of laryngeal adverse effects reported to the US Food and Drug Administration (FDA) after VNS implantation and to analyze associated VNS device problems.Design, Setting, and ParticipantsThis retrospective cross-sectional analysis queried the FDA Manufacturer and User Facility Device Experience database of adverse events in the US between 1996 and 2020.Main Outcomes and MeasuresThe primary outcome was the percent of adverse events reported to the FDA that included patients who received VNS with laryngeal adverse effects and the associated proportion of device problems after VNS surgery.ResultsA total of 12 725 iatrogenic vagus nerve issues were documented after VNS implantation, with apnea (n = 395; 3.1%) being the most common patient problem. Overall, 187 reports of laryngeal adverse effects associated with VNS devices were identified and represented the eighth most common iatrogenic vagus nerve problem reported to the FDA. Laryngeal adverse effects included 78 reports of voice alteration and 57 reports of paresis/paralysis. The VNS device problems frequently associated with laryngeal adverse effects were high impedance (n = 15, 8.02%), incorrect frequency delivery (n = 10, 5.35%), and battery problems (n = 11, 5.88%). The number of laryngeal adverse effect reports per year peaked in 2012 with 43 cases.Conclusions and RelevanceThis cross-sectional study found that although the literature demonstrates that vocal changes occur with nearly all VNS devices, the FDA receives adverse event reports of voice changes. Our results emphasize a potential need to improve patient counseling prior to VNS surgery to better set patient expectations regarding vocal changes and to prevent unnecessary patient concern. In addition, reports of vocal fold paresis/paralysis potentially suggest that patients may benefit from preoperative laryngeal assessment to differentiate preexisting vocal fold paralysis from that caused by VNS surgery.

show abstract

Epilepsy

Meyer¹

2016

Neurologic Disease

View full text Add to dashboard Cite

Vagus Nerve Stimulation in the Treatment of Refractory Epilepsy

Cited by 50 publications

References 106 publications

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Laryngology Outcomes Following Implantable Vagus Nerve Stimulation

Epilepsy

Contact Info

Product

Resources

About