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A Pediatric Patient With Seizures and Vagus Nerve Stimulation With Worsening Snoring and Apneas

Sameh S Morkous¹

¹Pediatric Neurology, Lehigh Valley Health Network (LVHN) Lehigh Valley Reilly Children's Hospital, Allentown, USA.

|May 14, 2021

Insights

Vagus nerve stimulation (VNS) can cause severe obstructive sleep apnea (OSA) in epilepsy patients. Screening for sleep-disordered breathing (SDB) before and after VNS implantation is crucial for early detection and management.

Area of Science:

Neurology
Sleep Medicine
Medical Devices

Background:

Epilepsy management often involves antiepileptic drugs and vagus nerve stimulation (VNS).
VNS is an effective treatment for intractable focal seizures, improving seizure control.
Respiratory complications following VNS implantation are not widely recognized.

Observation:

An 11-year-old female with epilepsy developed louder snoring and witnessed apneas after VNS implantation.
Polysomnography (PSG) revealed severe obstructive sleep apnea (OSA) in the patient.
The OSA was diagnosed as secondary to electrical activations from the VNS device.

Findings:

Vagus nerve stimulation (VNS) can be associated with the development of sleep-disordered breathing (SDB).
Electrical stimulation from VNS may trigger or exacerbate obstructive sleep apnea (OSA).
This case highlights a potential respiratory side effect of VNS therapy in epilepsy patients.

Implications:

Routine screening for SDB, including PSG, should be considered before and after VNS implantation.
Understanding the link between VNS and OSA can lead to better patient monitoring and management.
Further research into the mechanisms of VNS-induced SDB is warranted to optimize epilepsy treatment.

Read full analysis

Abstract:

An 11-year-old female presents to the sleep clinic for evaluation for possible sleep-disordered breathing (SDB). She has a history of frequently intractable seizures for which she was tried on multiple antiepileptic medications. She had vagus nerve stimulation (VNS) implantation two years ago to treat her focal seizures. Nine months later, her seizures were controlled, but the family raised concerns about louder snoring and more frequently witnessed apneas. She had polysomnography (PSG) that showed severe obstructive sleep apnea (OSA) related to her VNS. The patient was diagnosed with SDB secondary to electrical activations of the implanted VNS. We describe an epilepsy patient whose case illustrates the possible respiratory complications (primarily OSA) associated with VNS. We will discuss the possible mechanisms of VNS related SDB and the importance of screening for SDB and advocate for a PSG both before and after VNS implantation.

Keywords:

obstructive sleep apnea seizures vagus nerve stimulation

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