title: Late-onset periodic bradycardia during vagus nerve stimulation in a pediatric patient. A new case and review of the literature.
abstract: BACKGROUND
  Epilepsy is a common disease in the world. Around 10-40% of patients who suffer epilepsy will have intractable seizures. When resective epilepsy surgery is not possible, vagus nerve stimulation (VNS) can be an option. The most common side effects associated with VSN therapy are hoarseness, throat pain and coughing. Cardiac arrhythmia has been reported during lead tests performed during implantation of the device, but few cases during regular treatment. We report a new child where vagally induced bradyarrhythmia, perfectly correlated with the stimulation periods.
  
  
  METHODS
  13-year-old girl with refractory myoclonic-astatic epilepsy since the age of two. When she was five years old, a VNS was implanted with complete resolution of her seizures. But when she was 13, she began with sudden falls with loss of consciousness lasting less than 10 s, which were similar to her previous epileptic drop-attacks. Continuous ECG recording was normal but electrocardiography showed a bradycardia of 45 bpm with a syncope-like episode. It was necessary to turn off the VNS.
  
  
  CONCLUSIONS
  To our knowledge, there are just three pediatrics and four adults patients described in the literature with this severe and life-threatening side effect. Cardiac complications of VNS therapy are very infrequent but should alert clinicians to its possibility. A cardiac evaluation is mandatory before VNS implantation and periodically thereafter (probably between one or three years).
authors.affiliation: Department of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Avd. Menéndez Pelayo 65, 28009 Madrid, Spain. Electronic address: verocantarin@hotmail.com.
authors.forename: Verónica
authors.initials: V
authors.lastname: Cantarín-Extremera
authors.affiliation: Department of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Avd. Menéndez Pelayo 65, 28009 Madrid, Spain. Electronic address: mruiz.hnjs@salud.madrid.org.
authors.forename: María-Luz
authors.initials: ML
authors.lastname: Ruíz-Falcó-Rojas
authors.affiliation: Department of Pediatric Cardiology, Hospital Infantil Universitario Niño Jesús, Avd. Menéndez Pelayo 65, 28009 Madrid, Spain. Electronic address: amalia.tamarizmartel@salud.madrid.org.
authors.forename: Amalia
authors.initials: A
authors.lastname: Tamaríz-Martel-Moreno
authors.affiliation: Video-EEG Monitoring Unit, Neurophysiology Section, Hospital Infantil Universitario Niño Jesús, Avd. Menéndez Pelayo 65, 28009 Madrid, Spain. Electronic address: martagf@hotmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: García-Fernández
authors.affiliation: Department of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Avd. Menéndez Pelayo 65, 28009 Madrid, Spain. Electronic address: annaduatr@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Duat-Rodriguez
authors.affiliation: Department of Pediatric Neurosurgery, Hospital Infantil Universitario Niño Jesús, Avd. Menéndez Pelayo 65, 28009 Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Rivero-Martín
mesh_terms: D000293:Adolescent; D001919:Bradycardia / Q000175:diagnosis / Q000209:etiology*; D000069279:Drug Resistant Epilepsy / Q000628:therapy*; D004562:Electrocardiography; D004831:Epilepsies, Myoclonic / Q000628:therapy*; D005260:Female; D006801:Humans; D013575:Syncope / Q000175:diagnosis / Q000209:etiology*; D055536:Vagus Nerve Stimulation / Q000009:adverse effects*
keywords: Cardiac responses; Children; Chronic electrical stimulation; Epilepsy; Seizure; Vagus nerve stimulation