Complications of chronic vagus nerve stimulation for epilepsy in children

Matthew D. SmythPediatric Neurosurgery, Children's Hospital of Alabama; Department of Cell Biology and Division of Pediatric Neurology, University of Alabama at Birmingham; and the University of Alabama at Huntsville, Alabama

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R. Shane TubbsPediatric Neurosurgery, Children's Hospital of Alabama; Department of Cell Biology and Division of Pediatric Neurology, University of Alabama at Birmingham; and the University of Alabama at Huntsville, Alabama

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E. Martina BebinPediatric Neurosurgery, Children's Hospital of Alabama; Department of Cell Biology and Division of Pediatric Neurology, University of Alabama at Birmingham; and the University of Alabama at Huntsville, Alabama

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Paul A. GrabbPediatric Neurosurgery, Children's Hospital of Alabama; Department of Cell Biology and Division of Pediatric Neurology, University of Alabama at Birmingham; and the University of Alabama at Huntsville, Alabama

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Jeffrey P. BlountPediatric Neurosurgery, Children's Hospital of Alabama; Department of Cell Biology and Division of Pediatric Neurology, University of Alabama at Birmingham; and the University of Alabama at Huntsville, Alabama

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Object. The aim of this study was to define better the incidence of surgical complications and untoward side effects of chronic vagus nerve stimulation (VNS) in a population of children with medically refractory epilepsy.

Methods. The authors retrospectively reviewed the cases of 74 consecutive patients (41 male and 33 female) 18 years of age or younger (mean age 8.8 years, range 11 months–18 years) who had undergone implantation of a vagal stimulator between 1998 and 2001 with a minimum follow up of 1 year (mean 2.2 years). Of the 74 patients treated, seven (9.4%) had a complication ultimately resulting in removal of the stimulator. The rate of deep infections necessitating device removal was 3.5% (three of 74 patients who had undergone 85 implantation and/or revision procedures). An additional three superficial infections occurred in patients in whom the stimulators were not removed: one was treated with superficial operative debridement and antibiotic agents and the other two with oral antibiotics only. Another four stimulators (5.4%) were removed because of the absence of clinical benefit and device intolerance. Two devices were revised because of lead fracture (2.7%). Among the cohort, 11 battery changes have been performed thus far, although none less than 33 months after initial implantation. Several patients experienced stimulation-induced symptoms (hoarseness, cough, drooling, outbursts of laughter, shoulder abduction, dysphagia, or urinary retention) that did not require device removal. Ipsilateral vocal cord paralysis was identified in one patient. One patient died of aspiration pneumonia more than 30 days after device implantation.

Conclusions. Vagus nerve stimulation remains a viable option for improving seizure control in difficult to treat pediatric patients with epilepsy. Surgical complications such as hardware failure (2.7%) or deep infection (3.5%) occurred, resulting in device removal or revision. Occasional stimulation-induced symptoms such as hoarseness, dysphagia, or torticollis may be expected (5.4%).

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  • 1.

    Albright AL: Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol 11 (Suppl 1):S29S35, 1996 Albright AL: Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol 11 (Suppl 1):S29–S35, 1996

    • Search Google Scholar
    • Export Citation
  • 2.

    Anonymous: A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology 45:224230, 1995 Anonymous: A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology 45:224–230, 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    Bailey P, & Bremer F: A sensory cortical representation of the vagus nerve. With a note on the effects of low blood pressure on the cortical electrogram. J Neurophysiol 1:405412, 1938 Bailey P, Bremer F: A sensory cortical representation of the vagus nerve. With a note on the effects of low blood pressure on the cortical electrogram. J Neurophysiol 1:405–412, 1938

    • Search Google Scholar
    • Export Citation
  • 4.

    Bakay RA: Comment on Ko D, Heck C, Grafton S, et al: Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2 15O blood flow imaging. Neurosurgery 39:426431, 1996 Bakay RA: Comment on Ko D, Heck C, Grafton S, et al: Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2 15O blood flow imaging. Neurosurgery 39:426–431, 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Becker WJ, , Harris CJ, & Long ML, et al: Long-term intrathecal baclofen therapy in patients with intractable spasticity. Can J Neurol Sci 22:208217, 1995 Becker WJ, Harris CJ, Long ML, et al: Long-term intrathecal baclofen therapy in patients with intractable spasticity. Can J Neurol Sci 22:208–217, 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Camfield PR, & Camfield CS: Vagal nerve stimulation for treatment of children with epilepsy. J Pediatr 134:532533, 1999 Camfield PR, Camfield CS: Vagal nerve stimulation for treatment of children with epilepsy. J Pediatr 134:532–533, 1999

    • Search Google Scholar
    • Export Citation
  • 7.

    Charous SJ, , Kempster G, & Manders E, et al: The effect of vagal nerve stimulation on voice. Laryngoscope 111:20282031, 2001 Charous SJ, Kempster G, Manders E, et al: The effect of vagal nerve stimulation on voice. Laryngoscope 111:2028–2031, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Clarke BM, , Upton AR, & Griffin HM: Cognitive motor function after electrical stimulation of the vagus nerve. Pacing Clin Electrophysiol 15:16031607, 1992 Clarke BM, Upton AR, Griffin HM: Cognitive motor function after electrical stimulation of the vagus nerve. Pacing Clin Electrophysiol 15:1603–1607, 1992

    • Search Google Scholar
    • Export Citation
  • 9.

    Clarke BM, , Upton AR, & Kamath M, et al: Electrostimulation effects of the vagus nerve on balance in epilepsy. Pacing Clin Electrophysiol 15:16141630, 1992 Clarke BM, Upton AR, Kamath M, et al: Electrostimulation effects of the vagus nerve on balance in epilepsy. Pacing Clin Electrophysiol 15:1614–1630, 1992

    • Search Google Scholar
    • Export Citation
  • 10.

    Crumrine PK: Vagal nerve stimulation in children. Semin Pediatr Neurol 7:216223, 2000 Crumrine PK: Vagal nerve stimulation in children. Semin Pediatr Neurol 7:216–223, 2000

    • Search Google Scholar
    • Export Citation
  • 11.

    Garnett ES, , Nahmias C, & Scheffel A, et al: Regional cerebral blood flow in man manipulated by direct vagal stimulation. Pacing Clin Electrophysiol 15:15791580, 1992 Garnett ES, Nahmias C, Scheffel A, et al: Regional cerebral blood flow in man manipulated by direct vagal stimulation. Pacing Clin Electrophysiol 15:1579–1580, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    George R, , Salinsky M, & Kuzniecky R, et al: Vagus nerve stimulation for treatment of partial seizures: 3. Long-term follow-up on first 67 patients exiting a controlled study. First International Vagus Nerve Stimulation Study Group. Epilepsia 35:637643, 1994 George R, Salinsky M, Kuzniecky R, et al: Vagus nerve stimulation for treatment of partial seizures: 3. Long-term follow-up on first 67 patients exiting a controlled study. First International Vagus Nerve Stimulation Study Group. Epilepsia 35:637–643, 1994

    • Search Google Scholar
    • Export Citation
  • 13.

    Hammond EJ, , Uthman BM, & Reid SA, et al: Electrophysiological studies of cervical vagus nerve stimulation in humans: I. EEG effects. Epilepsia 33:10131020, 1992 Hammond EJ, Uthman BM, Reid SA, et al: Electrophysiological studies of cervical vagus nerve stimulation in humans: I. EEG effects. Epilepsia 33:1013–1020, 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Hammond EJ, , Uthman BM, & Wilder BJ, et al: Neurochemical effects of vagus nerve stimulation in humans. Brain Res 583:300303, 1992 Hammond EJ, Uthman BM, Wilder BJ, et al: Neurochemical effects of vagus nerve stimulation in humans. Brain Res 583:300–303, 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Handforth A, , DeGiorgio CM, & Schachter SC, et al: Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 51:4855, 1998 Handforth A, DeGiorgio CM, Schachter SC, et al: Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 51:48–55, 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Hariz MI: Complications of deep brain stimulation surgery. Mov Disord 17 (Suppl 3):S162S166, 2002 Hariz MI: Complications of deep brain stimulation surgery. Mov Disord 17 (Suppl 3):S162–S166, 2002

    • Search Google Scholar
    • Export Citation
  • 17.

    Holder LK, , Wernicke JF, & Tarver WB: Treatment of refractory partial seizures: preliminary results of a controlled study. Pacing Clin Electrophysiol 15:15571571, 1992 Holder LK, Wernicke JF, Tarver WB: Treatment of refractory partial seizures: preliminary results of a controlled study. Pacing Clin Electrophysiol 15:1557–1571, 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Iriarte J, , Artieda J, & Alegre M, et al: Spasm of the sternocleidomastoid muscle induced by vagal nerve stimulation. Neurology 57:23192320, 2001 Iriarte J, Artieda J, Alegre M, et al: Spasm of the sternocleidomastoid muscle induced by vagal nerve stimulation. Neurology 57:2319–2320, 2001

    • Search Google Scholar
    • Export Citation
  • 19.

    Kalkanis JG, , Krishna P, & Espinosa JA, et al: Self-inflicted vocal cord paralysis in patients with vagus nerve stimulators. Report of two cases. J Neurosurg 96:949951, 2002 Kalkanis JG, Krishna P, Espinosa JA, et al: Self-inflicted vocal cord paralysis in patients with vagus nerve stimulators. Report of two cases. J Neurosurg 96:949–951, 2002

    • Search Google Scholar
    • Export Citation
  • 20.

    Kamath MV, , Upton AR, & Talalla A, et al: Neurocardiac responses to vagoafferent electrostimulation in humans. Pacing Clin Electrophysiol 15:15811587, 1992 Kamath MV, Upton AR, Talalla A, et al: Neurocardiac responses to vagoafferent electrostimulation in humans. Pacing Clin Electrophysiol 15:1581–1587, 1992

    • Search Google Scholar
    • Export Citation
  • 21.

    Ko D, , Heck C, & Grafton S, et al: Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2 15O blood flow imaging. Neurosurgery 39:426431, 1996 Ko D, Heck C, Grafton S, et al: Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2 15O blood flow imaging. Neurosurgery 39:426–431, 1996

    • Search Google Scholar
    • Export Citation
  • 22.

    Kumar R, , Lang AE, & Rodriguez-Oroz MC, et al: Deep brain stimulation of the globus pallidus pars interna in advanced Parkinson's disease. Neurology 55 (Suppl 6):S34S39, 2000 Kumar R, Lang AE, Rodriguez-Oroz MC, et al: Deep brain stimulation of the globus pallidus pars interna in advanced Parkinson's disease. Neurology 55 (Suppl 6):S34–S39, 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Landy HJ, , Ramsay RE, & Slater J, et al: Vagus nerve stimulation for complex partial seizures: surgical technique, safety, and efficacy. J Neurosurg 78:2631, 1993 Landy HJ, Ramsay RE, Slater J, et al: Vagus nerve stimulation for complex partial seizures: surgical technique, safety, and efficacy. J Neurosurg 78:26–31, 1993

    • Search Google Scholar
    • Export Citation
  • 24.

    Le H, , Chico M, & Hecox K, et al: Interscapular placement of a vagal nerve stimulator pulse generator for prevention of wound tampering. Technical note. Pediatr Neurosurg 36:164166, 2002 Le H, Chico M, Hecox K, et al: Interscapular placement of a vagal nerve stimulator pulse generator for prevention of wound tampering. Technical note. Pediatr Neurosurg 36:164–166, 2002

    • Search Google Scholar
    • Export Citation
  • 25.

    Lockard JS, , Congdon WC, & DuCharme LL: Feasibility and safety of vagal stimulation in monkey model. Epilepsia 31 (Suppl 2):S20S26, 1990 Lockard JS, Congdon WC, DuCharme LL: Feasibility and safety of vagal stimulation in monkey model. Epilepsia 31 (Suppl 2):S20–S26, 1990

    • Search Google Scholar
    • Export Citation
  • 26.

    McLachlan RS: Suppression of interictal spikes and seizures by stimulation of the vagus nerve. Epilepsia 34:918923, 1993 McLachlan RS: Suppression of interictal spikes and seizures by stimulation of the vagus nerve. Epilepsia 34:918–923, 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Morrow JI, , Bingham E, & Craig JJ, et al: Vagal nerve stimulation in patients with refractory epilepsy. Effect on seizure frequency, severity and quality of life. Seizure 9:442445, 2000 Morrow JI, Bingham E, Craig JJ, et al: Vagal nerve stimulation in patients with refractory epilepsy. Effect on seizure frequency, severity and quality of life. Seizure 9:442–445, 2000

    • Search Google Scholar
    • Export Citation
  • 28.

    Murphy JV: Left vagal nerve stimulation in children with medically refractory epilepsy. The Pediatric VNS Study Group. J Pediatr 134:563566, 1999 Murphy JV: Left vagal nerve stimulation in children with medically refractory epilepsy. The Pediatric VNS Study Group. J Pediatr 134:563–566, 1999

    • Search Google Scholar
    • Export Citation
  • 29.

    Murphy JV, , Wheless JW, & Schmoll CM: Left vagal nerve stimulation in six patients with hypothalamic hamartomas. Pediatr Neurol 23:167168, 2000 Murphy JV, Wheless JW, Schmoll CM: Left vagal nerve stimulation in six patients with hypothalamic hamartomas. Pediatr Neurol 23:167–168, 2000

    • Search Google Scholar
    • Export Citation
  • 30.

    Naritoku DK, , Morales A, & Pencek TL, et al: Chronic vagus nerve stimulation increases the latency of the thalamocortical somatosensory evoked potential. Pacing Clin Electrophysiol 15:15721578, 1992 Naritoku DK, Morales A, Pencek TL, et al: Chronic vagus nerve stimulation increases the latency of the thalamocortical somatosensory evoked potential. Pacing Clin Electrophysiol 15:1572–1578, 1992

    • Search Google Scholar
    • Export Citation
  • 31.

    Neufeld M, , Quaknine G, & Korczyn A: [Vagus nerve stimulation for partial seizures.] Harefuah 129:57, 80, 1995 (Hebrew) Neufeld M, Quaknine G, Korczyn A: [Vagus nerve stimulation for partial seizures.] Harefuah 129:5–7, 80, 1995 (Hebrew)

    • Search Google Scholar
    • Export Citation
  • 32.

    Patwardhan RV, , Stong B, & Bebin EM, et al: Efficacy of vagal nerve stimulation in children with medically refractory epilepsy. Neurosurgery 47:13531358, 2000 Patwardhan RV, Stong B, Bebin EM, et al: Efficacy of vagal nerve stimulation in children with medically refractory epilepsy. Neurosurgery 47:1353–1358, 2000

    • Search Google Scholar
    • Export Citation
  • 33.

    Penry JK, & Dean JC: Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 31 (Suppl 2):S40S43, 1990 Penry JK, Dean JC: Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 31 (Suppl 2):S40–S43, 1990

    • Search Google Scholar
    • Export Citation
  • 34.

    Ricardo JA, & Koh ET: Anatomical evidence of direct projections from the nucleus of the solitary tract to the hypothalamus, amygdala, and other forebrain structures in the rat. Brain Res 153:126, 1978 Ricardo JA, Koh ET: Anatomical evidence of direct projections from the nucleus of the solitary tract to the hypothalamus, amygdala, and other forebrain structures in the rat. Brain Res 153:1–26, 1978

    • Search Google Scholar
    • Export Citation
  • 35.

    Rutecki P: Anatomical, physiological, and theoretical basis for the antiepileptic effect of vagus nerve stimulation. Epilepsia 31 (Suppl 2):S1S6, 1990 Rutecki P: Anatomical, physiological, and theoretical basis for the antiepileptic effect of vagus nerve stimulation. Epilepsia 31 (Suppl 2):S1–S6, 1990

    • Search Google Scholar
    • Export Citation
  • 36.

    Salinsky MC, & Burchiel KJ: Vagus nerve stimulation has no effect on awake EEG rhythms in humans. Epilepsia 34:299304, 1993 Salinsky MC, Burchiel KJ: Vagus nerve stimulation has no effect on awake EEG rhythms in humans. Epilepsia 34:299–304, 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Tubbs RS, , Patwardhan R, & Palmer CA, et al: Histological appearance of a chronically stimulated vagus nerve in a pediatric patient. Pediatr Neurosurg 35:99102, 2001 Tubbs RS, Patwardhan R, Palmer CA, et al: Histological appearance of a chronically stimulated vagus nerve in a pediatric patient. Pediatr Neurosurg 35:99–102, 2001

    • Search Google Scholar
    • Export Citation
  • 38.

    Uthman BM, , Wilder BJ, & Hammond EJ, et al: Efficacy and safety of vagus nerve stimulation in patients with complex partial seizures. Epilepsia 31 (Suppl 2):S44S50, 1990 Uthman BM, Wilder BJ, Hammond EJ, et al: Efficacy and safety of vagus nerve stimulation in patients with complex partial seizures. Epilepsia 31 (Suppl 2):S44–S50, 1990

    • Search Google Scholar
    • Export Citation
  • 39.

    Woodbury DM, & Woodbury JW: Effects of vagal stimulation on experimentally induced seizures in rats. Epilepsia 31 (Suppl 2):S7S19, 1990 Woodbury DM, Woodbury JW: Effects of vagal stimulation on experimentally induced seizures in rats. Epilepsia 31 (Suppl 2):S7–S19, 1990

    • Search Google Scholar
    • Export Citation
  • 40.

    Woodbury JW, & Woodbury DM: Vagal stimulation reduces the severity of maximal electroshock seizures in intact rats: use of a cuff electrode for stimulating and recording. Pacing Clin Electrophysiol 14:94107, 1991 Woodbury JW, Woodbury DM: Vagal stimulation reduces the severity of maximal electroshock seizures in intact rats: use of a cuff electrode for stimulating and recording. Pacing Clin Electrophysiol 14:94–107, 1991

    • Search Google Scholar
    • Export Citation
  • 41.

    Zanchetti A, , Wang SC, & Moruzzi G: The effect of vagal afferent stimulation on the EEG pattern of the cat. Electroencephalogr Clin Neurophysiol 4:357361, 1952 Zanchetti A, Wang SC, Moruzzi G: The effect of vagal afferent stimulation on the EEG pattern of the cat. Electroencephalogr Clin Neurophysiol 4:357–361, 1952

    • Search Google Scholar
    • Export Citation

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