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Trigeminal pain under vagus nerve stimulation.
Astrid Carius1, Andreas Schulze-Bonhage
1Epilepsy Center, University Hospital of Freiburg, Breisacher Strasse 64, D-79106 Freiburg, Germany. carius@nz11.ukl.uni-freiburg.de
Pain
|October 6, 2005
Summary
Vagus nerve stimulation (VNS) for epilepsy may cause trigeminal pain, perceived as toothache. This side effect is linked to stimulation intensity and can be reversed or habituated, highlighting VNS
Area of Science:
- Neurology
- Neurosurgery
- Pain Medicine
Background:
- Vagus nerve stimulation (VNS) is an established therapy for refractory epilepsy.
- The VNS device delivers electrical impulses to the vagus nerve, modulating neural activity.
- Potential side effects of VNS require careful monitoring and understanding.
Purpose of the Study:
- To investigate the occurrence and characteristics of trigeminal pain in epilepsy patients undergoing VNS.
- To determine the relationship between VNS parameters and the onset of trigeminal pain.
- To assess the reversibility and management of VNS-induced trigeminal pain.
Main Methods:
- Case series involving three epilepsy patients treated with cyclic continuous VNS.
- Detailed recording of patient-reported symptoms, including pain characteristics, location, and timing.
- Correlation analysis between VNS stimulation current intensity (SCI) and symptom onset/resolution.
Main Results:
- Three patients reported trigeminal pain, described as toothache in the left lower jaw, ipsilateral to VNS.
- Pain onset occurred days to weeks after increasing SCI.
- Trigeminal pain resolved upon decreasing SCI or through habituation.
Conclusions:
- Clinically significant effects of VNS on nociception are possible.
- VNS-induced trigeminal pain may be overlooked due to its late onset and variable presentation.
- Recognition of this side effect is crucial to avoid misdiagnosis and unnecessary procedures.