Michael Vaiman1, Eli Heyman2, Gad Lotan3. 1. Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 33 Shapiro Street, 59561, Bat Yam, Israel. vaimed@yahoo.com. 2. Pediatric Epilepsy Service, Pediatric Neurology Department, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Pediatric Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
INTRODUCTION: The vagus nerve stimulation (VNS) is used for treatment of drug-resistant epilepsy but laryngeal side effects are common. We tried to improve VNS by modifying the implantation procedure. The aim was to reduce the rate of side effects that have prevented using VNS to its full capacity. METHODS: We operated on 74 pediatric patients for VNS device implantation using a modified surgical protocol incorporating lower neck incision for electrode placement and 36 patients who were operated by standard technique were used for control group. We retrospectively analyzed reduction in frequency of seizures, reduction in severity of seizures (assessed by the shortened Ictal/post-ictal subscale of the Liverpool Seizure Severity Scale that included falling to the ground, postictal headache and sleepiness, incontinence, tongue biting, and injury during attack). RESULTS: Using the new implantation technique, side effects related directly to VNS therapy occurred in six cases (8.1%) showing statistically sound improvement over the standard implantation technique (p ˂ 0.05). To achieve good results, the maximum stimulation (3.5 mA) was used in 24 patients (32.4%), with no laryngeal side effects detected. Twelve patients (16.2%) were seizure-free after the first year of VNS treatment. 74.3% of patients experienced a 50% reduction in seizure frequency and improved ictal or postictal activity. CONCLUSION: To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique may be modified, and lower neck incision could be used. A low rate of laryngeal side effects allows using the VNS device to its full electrical capacity.
INTRODUCTION: The vagus nerve stimulation (VNS) is used for treatment of drug-resistant epilepsy but laryngeal side effects are common. We tried to improve VNS by modifying the implantation procedure. The aim was to reduce the rate of side effects that have prevented using VNS to its full capacity. METHODS: We operated on 74 pediatric patients for VNS device implantation using a modified surgical protocol incorporating lower neck incision for electrode placement and 36 patients who were operated by standard technique were used for control group. We retrospectively analyzed reduction in frequency of seizures, reduction in severity of seizures (assessed by the shortened Ictal/post-ictal subscale of the Liverpool Seizure Severity Scale that included falling to the ground, postictal headache and sleepiness, incontinence, tongue biting, and injury during attack). RESULTS: Using the new implantation technique, side effects related directly to VNS therapy occurred in six cases (8.1%) showing statistically sound improvement over the standard implantation technique (p ˂ 0.05). To achieve good results, the maximum stimulation (3.5 mA) was used in 24 patients (32.4%), with no laryngeal side effects detected. Twelve patients (16.2%) were seizure-free after the first year of VNS treatment. 74.3% of patients experienced a 50% reduction in seizure frequency and improved ictal or postictal activity. CONCLUSION: To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique may be modified, and lower neck incision could be used. A low rate of laryngeal side effects allows using the VNS device to its full electrical capacity.
Authors: Daniel J Kirse; Andreas H Werle; Jerome V Murphy; Thomas P Eyen; Daniel E Bruegger; Gregory W Hornig; Richard D Torkelson Journal: Arch Otolaryngol Head Neck Surg Date: 2002-11