title: The therapeutic dilemma of vagus nerve stimulator-induced sleep disordered breathing.
abstract: Intermittent vagus nerve stimulation (VNS) can reduce the frequency of seizures in patients with refractory epilepsy, but can affect respiration in sleep. Untreated obstructive sleep apnea (OSA) can worsen seizure frequency. Unfortunately, OSA and VNS-induced sleep disordered breathing (SDB) may occur in the same patient, leading to a therapeutic dilemma. We report a pediatric patient in whom OSA improved after tonsillectomy, but coexistent VNS-induced SDB persisted. With decrease in VNS output current, patient's SDB improved, but seizure activity exacerbated, which required a return to the original settings. Continuous positive airway pressure titration was attempted, which showed only a partial improvement in apnea-hypopnea index. This case illustrates the need for clinicians to balance seizure control and SDB in patients with VNS.
authors.affiliation: Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA.
authors.forename: Hinesh
authors.initials: H
authors.lastname: Upadhyay
authors.affiliation: Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA.
authors.forename: Sushanth
authors.initials: S
authors.lastname: Bhat
authors.affiliation: Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA.
authors.forename: Divya
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Department of Neurosciences and Neurology, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Mulvey
authors.affiliation: Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA; Department of Neurosciences and Neurology, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Ming
keywords: Epilepsy; obstructive sleep apnea; seizure; vagus nerve stimulator