Revision or removal of vagus nerve stimulator lead and implantable pulse generator

Author(s):  
Jeffrey E. Arle
2020 ◽  
Vol 99 (7) ◽  

Introduction: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region. Methods: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.1−58.4 years). Results: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches. Conclusion: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Imad Libbus ◽  
Scott R. Stubbs ◽  
Scott T. Mazar ◽  
Scott Mindrebo ◽  
Bruce H. KenKnight ◽  
...  

Abstract Background Vagus Nerve Stimulation (VNS) delivers Autonomic Regulation Therapy (ART) for heart failure (HF), and has been associated with improvement in cardiac function and heart failure symptoms. VNS is delivered using an implantable pulse generator (IPG) and lead with electrodes placed around the cervical vagus nerve. Because HF patients may receive concomitant cardiac defibrillation therapy, testing was conducted to determine the effect of defibrillation (DF) on the VNS system. Methods DF testing was conducted on three ART IPGs (LivaNova USA, Inc.) according to international standard ISO14708-1, which evaluated whether DF had any permanent effects on the system. Each IPG was connected to a defibrillation pulse generator and subjected to a series of high-energy pulses. Results The specified series of pulses were successfully delivered to each of the three devices. All three IPGs passed factory electrical tests, and interrogation confirmed that software and data were unchanged from the pre-programmed values. No shifts in parameters or failures were observed. Conclusions Implantable VNS systems were tested for immunity to defibrillation, and were found to be unaffected by a series of high-energy defibrillation pulses. These results suggest that this VNS system can be used safely and continue to function after patients have been defibrillated.


2021 ◽  
Vol 71 ◽  
pp. 110193
Author(s):  
Arthur Chyan ◽  
Sangeeta Kumaraswami ◽  
Suryanarayana Pothula

2016 ◽  
Vol 30 ◽  
pp. 83-87 ◽  
Author(s):  
Sandi Lam ◽  
Yimo Lin ◽  
Daniel J. Curry ◽  
Gaddum D. Reddy ◽  
Peter C. Warnke

2009 ◽  
Vol 41 (5) ◽  
pp. 383-387 ◽  
Author(s):  
Naoaki Tanaka ◽  
Elizabeth A. Thiele ◽  
Joseph R. Madsen ◽  
Blaise F. Bourgeois ◽  
Steven M. Stufflebeam

2016 ◽  
Vol 11 (2) ◽  
pp. 151 ◽  
Author(s):  
Hinaesh Upadhyay ◽  
Sushanth Bhat ◽  
Divya Gupta ◽  
Martha Mulvey ◽  
Sue Ming

2012 ◽  
Vol 10 (3) ◽  
pp. 226-229 ◽  
Author(s):  
Will P. Rodgers ◽  
Andrew J. Durnford ◽  
Fenella J. Kirkham ◽  
Andrea Whitney ◽  
Mark A. Mullee ◽  
...  

Object Interrater reliability as measured by the kappa (κ) statistic is a widely used and valuable tool to measure the robustness of a scoring system. Seizure frequency reduction is a central outcome measure following vagus nerve stimulation (VNS). A specific VNS scoring system has been proposed by McHugh, but its interrater reliability has not been tested. The authors assessed its interrater reliability and compared it with that of the Engel and International League Against Epilepsy (ILAE) systems. Methods Using the Engel, ILAE, and McHugh scoring systems, 3 observers independently rated the medical records of children who had undergone vagus nerve stimulator implantation between January 2001 and April 2011 at the Southampton University Hospital. The interrater agreements were then calculated using the κ statistic. Results Interrater reliability for the McHugh scale (κ0.693) was very good and was superior to those of the Engel (κ0.464) and ILAE (κ0.491) systems for assessing outcome in patients undergoing VNS. Conclusions The authors recommend considering the McHugh scoring system when assessing outcomes following VNS.


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