Aspiration: a potential complication to vagus nerve stimulation.
OBJECTIVE
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.
Lundgren
J
J
Department of Pediatrics, University Hospital, Lund, Sweden.
Ekberg
O
O
Olsson
R
R
D000293:Adolescent; D000328:Adult; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D004827:Epilepsy / Q000628:therapy*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D001239:Inhalation; D011859:Radiography; D014630:Vagus Nerve / Q000502:physiology*; D014743:Videotape Recording
D001466:Barium Sulfate