title: Insulation discontinuity in a vagus nerve stimulator lead: a treatable cause of intolerable stimulation-related symptoms.
abstract: Discontinuity in the silicone insulation over an electrode of a left vagus nerve stimulator (VNS) allowed the aberrant leak of current to the phrenic nerve and other structures. This resulted in ipsilateral diaphragmatic dysfunction, inability to vocalize, and severe radiating pain into the jaw and upper incisor for the duration of each stimulation. The device was explanted and a new device was implanted. All stimulation-related symptoms ceased immediately. A similar discontinuity in the silicone insulation is the likely explanation for several prior reports of poorly understood pains and phrenic nerve stimulation in patients with VNSs. The findings and analysis of this case establish a rationale for consideration of replacement of the VNS lead in all similarly symptomatic patients.
authors: Department of Neurology, The University of Colorado at Denver Health Science Center, Denver, Colorado, USA.
authors: Mark C
authors: MC
authors: Spitz
authors: Ken R
authors: KR
authors: Winston
authors: Edward H
authors: EH
authors: Maa
authors: Steven G
authors: SG
authors: Ojemann
mesh_terms: D003964:Diaphragm / Q000294:innervation / Q000503:physiopathology; D004553:Electric Conductivity; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D005157:Facial Pain / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010791:Phrenic Nerve / Q000503:physiopathology; D019233:Retreatment; D012828:Silicones; D013064:Speech Disorders / Q000209:etiology / Q000503:physiopathology; D055536:Vagus Nerve Stimulation / Q000009:adverse effects* / Q000295:instrumentation*
chemical_list: D012828:Silicones