Vagal Nerve Stimulator

Aka: Vagal Nerve Stimulator, Vagus Nerve Electrical Stimulator, Vagal Nerve Stimulation for Seizure Management, Vagus Nerve Electrical Stimulation for Refractory Epilepsy

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II. Mechanism

  1. Peripheral Nerve stimulator that applies electrical impulses to the Vagus Nerve
  2. Implantable electrical generator is connected to lead wires, tunneled subcutaneously to the Vagus Nerve
  3. Generator is programmed externally
    1. Device does not provide continuous stimulation
    2. Device is programmed to deliver stimulation at a specific frequency and pattern (e.g. hourly discharge)

III. Indications

  1. Seizure Disorder
    1. Symptomatic localization-related Epilepsy with multiple and bilateral independent foci
    2. Symptomatic Generalized Epilepsy with diffuse epileptogenic abnormalities
    3. Refractory idiopathic Generalized Epilepsy
    4. Failed intracranial Epilepsy surgery
    5. Epilepsy surgery contraindicated
  2. Major Depression
    1. Treatment resistant Major Depression

IV. Adverse Effects

  1. Hoarseness
  2. Throat pain or Dysphagia
  3. Cough
  4. Shortness of Breath

V. Management: Disabling Vagal Nerve Stimulator

  1. Indications
    1. See Adverse Effects above
  2. Risks
    1. Rarely, Bradycardia and Asystole have been reported on disabling a Vagal Nerve Stimulator
    2. Paradoxical stimulation of vagal nerve resulting in the same adverse effects that lead to disabling the device
      1. Magnet applied over device will disable it, but removal of the magnet stimulates the device
      2. Persistent disabling of the device requires that the magnet remain in place
  3. Technique
    1. Obtain magnet
      1. Patients are given a properly sized and shaped magnet with device implantation
      2. Emergency Department has magnets for disabling devices such as Pacemakers and Defibrillators
        1. Bar sized magnet is preferred
    2. Locate the device (typically subcutaneous in left chest)
    3. Apply the magnet over the device
      1. Exercise caution to avoid sliding on and off the device (which will trigger the stimulator)
    4. Secure the magnet in position

VI. Management: Triggering Vagal Nerve Stimulator

  1. Indications
    1. Seizure or other original indication for the device
  2. Technique
    1. Obtain Magnet (see above)
    2. Locate the device (typically subcutaneous in left chest)
    3. Apply the magnet over the device for 1-2 seconds and then quickly remove the magnet
    4. Repeat as needed

VII. References

  1. Warrington (2019) Crit Dec Emerg Med 33(7): 24
  2. Yamamoto (2015) Neurol Med Chir 55(5): 407-15. +PMID: 25925759 [PubMed]
  3. Ohemeng (2020) Otolaryngol Clin North Am 53(1):127-43 +PMID: 31685239 [PubMed]

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