Management of vagal nerve stimulator infections: do they need to be removed?

Clinical article

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Object

Vagal nerve stimulators (VNSs) have been used successfully to treat medically refractory epilepsy. Although their efficacy is well established, appropriate management of infections is less clearly defined. In the authors' experience, patients who have gained a benefit from VNS implantation have been reluctant to have the device removed. The authors therefore sought conservative management options to salvage infected VNS systems.

Methods

The authors performed a retrospective review of 191 (93 female and 98 male) consecutive patients in whom VNS systems were placed between 2000 and 2007.

Results

They identified 10 infections (5.2%). In 9 of 10 patients the cultured organism was Staphylococcus aureus. Three (30%) of 10 patients underwent early removal (within 1 month) of the VNS as the initial treatment. The remaining 7 patients were initially treated with antibiotics. Two (28.6%) of these patients were successfully treated using antibiotics without VNS removal. Patients in whom conservative treatment failed were given cephalexin as first-line antibiotic treatment. All patients recovered completely regardless of treatment regimen.

Conclusions

This study confirms the low rate of infection associated with VNS placement and suggests that, in the case of infection, treatment without removal is a viable option. However, the authors' data suggest that oral antibiotics are not the best first-line therapy.

Abbreviation used in this paper: VNS = vagal nerve stimulator.
Article Information

Contributor Notes

Address correspondence to: Francesco T. Mangano, D.O., Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45220-3029. email: Francesco.Mangano@cchmc.org.

© Copyright 1944-2019 American Association of Neurological Surgeons

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References
  • 1

    Alexopoulos AVKotagal PLoddenkemper THammel JBingaman WE: Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy. Seizure 15:4915032006

    • Search Google Scholar
    • Export Citation
  • 2

    Amar APDeGiorgio CMTarver WBApuzzo ML: Longterm multicenter experience with vagus nerve stimulation for intractable partial seizures: results of the XE5 trial. Stereotact Funct Neurosurg 73:1041081999

    • Search Google Scholar
    • Export Citation
  • 3

    Anonymous: A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology 45:2242301995

    • Search Google Scholar
    • Export Citation
  • 4

    Anwar HStrap JLCosterton JW: Eradication of biofilm cells of Staphylococcus aureus with tobramycin and cephalexin. Can J Microbiol 38:6186251992

    • Search Google Scholar
    • Export Citation
  • 5

    Ben-Menachem E: Vagus nerve stimulation, side effects, and long-term safety. J Clin Neurophysiol 18:4154182001

  • 6

    Ben-Menachem EHellstrom KVerstappen D: Analysis of direct hospital costs before and 18 months after treatment with vagus nerve stimulation therapy in 43 patients. Neurology 59:44472002

    • Search Google Scholar
    • Export Citation
  • 7

    Boon PD'Have MVan Walleghem PMichielsen GVonck KCaemaert J: Direct medical costs of refractory epilepsy incurred by three different treatment modalities: a prospective assessment. Epilepsia 43:961022002

    • Search Google Scholar
    • Export Citation
  • 8

    Boon PVonck KVandekerckhove TD'Have MNieuwenhuis LMichielsen G: Vagus nerve stimulation for medically refractory epilepsy; efficacy and cost-benefit analysis. Acta Neurochir (Wien) 141:4474531999

    • Search Google Scholar
    • Export Citation
  • 9

    DeGiorgio CMSchachter SCHandforth ASalinsky MThompson JUthman B: Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 41:119512002000

    • Search Google Scholar
    • Export Citation
  • 10

    Handforth AOndo WGTatter SMathern GWSimpson RK JrWalker F: Vagus nerve stimulation for essential tremor: a pilot efficacy and safety trial. Neurology 61:140114052003

    • Search Google Scholar
    • Export Citation
  • 11

    Khurana DSReumann MHobdell EFNeff SValencia ILegido A: Vagus nerve stimulation in children with refractory epilepsy: unusual complications and relationship to sleep-disordered breathing. Childs Nerv Syst 23:130913122007

    • Search Google Scholar
    • Export Citation
  • 12

    Kirse DJWerle AHMurphy JVEyen TPBruegger DEHornig GW: Vagus nerve stimulator implantation in children. Arch Otolaryngol Head Neck Surg 128:1263 12682002

    • Search Google Scholar
    • Export Citation
  • 13

    Liechty PGTubbs RSBlount JP: The use of a sump antibiotic irrigation system to save infected hardware in a patient with a vagal nerve stimulator: technical note. Surg Neurol 65:48502006

    • Search Google Scholar
    • Export Citation
  • 14

    Murphy JVTorkelson RDowler ISimon SHudson S: Vagal nerve stimulation in refractory epilepsy: the first 100 patients receiving vagal nerve stimulation at a pediatric epilepsy center. Arch Pediatr Adolesc Med 157:5605642003

    • Search Google Scholar
    • Export Citation
  • 15

    Ortler MLuef GKofler ABauer GTwerdy K: Deep wound infection after vagus nerve stimulator implantation: treatment without removal of the device. Epilepsia 42:1331352001

    • Search Google Scholar
    • Export Citation
  • 16

    Patel NCEdwards MS: Vagal nerve stimulator pocket infections. Pediatr Infect Dis J 23:6816832004

  • 17

    Ramsay REUthman BMAugustinsson LEUpton ARNaritoku DWillis J: Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side effects, and tolerability. First International Vagus Nerve Stimulation Study Group. Epilepsia 35:6276361994

    • Search Google Scholar
    • Export Citation
  • 18

    Raymond DPKuehnert MJSawyer RG: Preventing antimicrobial-resistant bacterial infections in surgical patients. CDC/SIS position paper. Surg Infect (Larchmt) 3:3753852002

    • Search Google Scholar
    • Export Citation
  • 19

    Salinsky MCUthman BMRistanovic RKWernicke JFTarver WB: Vagus nerve stimulation for the treatment of medically intractable seizures. Results of a 1-year open-extension trial. Vagus Nerve Stimulation Study Group. Arch Neurol 53:117611801996

    • Search Google Scholar
    • Export Citation
  • 20

    Smyth MDTubbs RSBebin EMGrabb PABlount JP: Complications of chronic vagus nerve stimulation for epilepsy in children. J Neurosurg 99:5005032003

    • Search Google Scholar
    • Export Citation
  • 21

    Wakai SKotagal P: Vagus nerve stimulation for children and adolescents with intractable epilepsies. Pediatr Int 43:61 652001

  • 22

    You SJKang HCKim HDKo TSKim DSHwang YS: Vagus nerve stimulation in intractable childhood epilepsy: a Korean multicenter experience. J Korean Med Sci 22:4424452007

    • Search Google Scholar
    • Export Citation
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