Neurology Book

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Vagal Nerve Stimulator

Aka: Vagal Nerve Stimulator, Vagus Nerve Electrical Stimulator, Vagal Nerve Stimulation for Seizure Management, Vagus Nerve Electrical Stimulation for Refractory Epilepsy
  1. See Also
    1. Vagus Nerve
  2. 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)
  3. 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
  4. Adverse Effects
    1. Hoarseness
    2. Throat pain or Dysphagia
    3. Cough
    4. Shortness of Breath
  5. 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
  6. 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
  7. 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]

Stimulators, Electrical, Vagus Nerve, Antiseizure (C0810618)

Definition (UMD) Peripheral-nerve electrical stimulators that apply periodic stimuli to the vagus nerve with appropriate characteristics (e.g., intensity, frequency, pulse shape) to treat seizures. These stimulators consist of a pulse generator typically implanted in the anterior chest wall and lead wires that run subcutaneously to electrodes implanted around the left vagus nerve. Vagus-nerve stimulators can be programmed externally following implantation (e.g., using a programming wand, dedicated software, and a standard personal computer). These stimulators are used in the treatment of epilepsy to eliminate seizures or to reduce seizure frequency and/or intensity.
Concepts Medical Device (T074)
English Stimulators, Vagus Nerve, Epilepsy, Stimulators, Electrical, Vagus Nerve, Antiseizure, Stimulators, Autonomic Nerve, Antiseizure
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Stimulators, Electrical, Vagus Nerve (C1458051)

Definition (UMD) Peripheral-nerve electrical stimulators that apply stimuli to the vagus nerve. These stimulators typically consist of an implantable electrical generator and lead wires that run subcutaneously to electrodes implanted around the vagus nerve; they usually can be programmed externally following implantation. Vagus nerve stimulators are intended for treatment seizures and/or other neurological disorders such as sleep apnea, depression, migraine, and dementia.
Concepts Medical Device (T074)
English Stimulators, Electrical, Vagus Nerve, Vagus Nerve Electrical Stimulators
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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