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Complications of chronic vagus nerve stimulation for epilepsy in children
Matthew D Smyth1, R Shane Tubbs, E Martina Bebin
1Pediatric Neurosurgery, Children's Hospital of Alabama, Alabama, USA. matthew.smyth@ccc.uab.edu
Insights
Chronic vagus nerve stimulation (VNS) is effective for pediatric epilepsy, though surgical complications like infection (3.5%) and hardware failure (2.7%) can occur. Some patients experience manageable side effects, but VNS remains a viable treatment option.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epilepsy Management
Background:
- Medically refractory epilepsy in children poses significant treatment challenges.
- Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy.
Purpose of the Study:
- To determine the incidence of surgical complications and side effects associated with chronic VNS in pediatric epilepsy patients.
- To evaluate the safety and efficacy of VNS as a treatment for refractory epilepsy in children.
Main Methods:
- Retrospective review of 74 pediatric patients (≤18 years) who underwent VNS implantation between 1998-2001.
- Minimum follow-up of 1 year (mean 2.2 years) to assess complications and outcomes.
Main Results:
- 9.4% of patients experienced complications requiring stimulator removal.
- Deep infection rate was 3.5%, and hardware failure (lead fracture) occurred in 2.7%.
- 5.4% of stimulators were removed due to lack of benefit or intolerance; manageable stimulation-induced symptoms were also noted.
Conclusions:
- Vagus nerve stimulation is a viable treatment for pediatric epilepsy refractory to other therapies.
- Surgical complications, including deep infection and hardware failure, necessitate careful monitoring.
- While occasional side effects occur, VNS offers a valuable option for seizure control in challenging pediatric cases.
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%).
