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Aspiration: a potential complication to vagus nerve stimulation
J Lundgren1, O Ekberg, R Olsson
1Department of Pediatrics, University Hospital, Lund, Sweden.
Insights
Vagus nerve stimulation (VNS) may worsen swallowing difficulties and aspiration in some children, particularly those with disabilities. Adjusting VNS settings or temporarily disabling it can help prevent aspiration risks.
Area of Science:
- Neurology
- Pediatrics
- Gastroenterology
Background:
- Vagus nerve stimulation (VNS) is a recognized treatment for reducing seizure frequency in pediatric and adult epilepsy.
- While generally safe, clinical observations suggest potential swallowing difficulties associated with VNS therapy.
Purpose of the Study:
- To investigate the impact of Vagus nerve stimulation (VNS) on swallowing function and aspiration in children.
- To assess aspiration risk in pediatric patients undergoing VNS therapy under different stimulation settings.
Main Methods:
- Videoradiography during barium swallow was used to evaluate 7 children (ages 4-18) with VNS.
- Swallowing function was assessed with VNS off, programmed, and in continuous stimulation modes.
- Aspiration was quantified using a 0-3 scoring system.
Main Results:
- Five of seven children with reported transient swallowing issues showed no significant change in aspiration.
- Two children with pre-existing swallowing difficulties exhibited increased aspiration scores during continuous VNS stimulation.
- One child also showed increased aspiration with programmed VNS, particularly those with severe cognitive and motor impairments.
Conclusions:
- Patients undergoing VNS therapy require pre-treatment and ongoing evaluation for swallowing problems.
- Implementing an easily accessible on/off mechanism for VNS devices is crucial to mitigate aspiration risks.
- Aspiration is a serious complication of VNS that necessitates careful management, especially in vulnerable pediatric populations.
Purpose:
Vagus nerve stimulation (VNS) is reported to reduce the frequency of seizures in children and adults without causing serious side effects. However, clinical observation of swallowing difficulties in 2 children treated with VNS made further investigation necessary.
Methods:
Seven patients aged 4-18 years and treated with VNS for 6-14 months were investigated with videoradiography during barium swallow. The children performed 5-30 barium swallow investigations with the VNS device turned off, running as programmed, or set at continuous stimulations. The degree of aspiration was scored from 0 to 3.
Results:
In 5 of 7 children, of whom reported transient swallowing difficulties, no change in the degree of aspiration was noted. The 2 children with swallowing difficulties, however. showed increased aspiration score when the stimulator was set at continuous stimulations. In 1 the score also appeared to increase with the VNS running as programmed (p > 0.05). Both children had severe mental and motor disabilities.
Conclusions:
Before and during VNS treatment patients should be evaluated with regard to swallowing problems. There needs to be an easy way to turn the device on and off to avoid aspirations, a hazardous and potentially life-threatening complication of VNS.