Abstracts

Rationale: Vagus Nerve Stimulator generators have been most typically sited in the left clavicular area but sometimes elsewhere for cosmetic reasons, e.g. the left mid axillary line. People with intellectual disabilities often have other physical conditions that might affect the accessibility of the generator for magnet stimulation or which might cause other difficulties, such as associated bone disease, or the use of supportive equipment including wheelchairs, orthotic appliances, hoists and body braces. Other factors influencing effectiveness might include the nature of any involuntary movements, whether seizure-related or not. Methods: Because we observed problems in a small number of cases due to these issues, we have worked with our service users, their carers and the surgical team to produce a protocol for identifying optimum generator positioning for each person before having surgery. The presurgical screening process involves consideration of all assistive technology and equipment currently in use and likely to be used in the future, including photographing the person using the equipment to ensure accessibility for magnet stimulation. Note is also made of special aspects of seizure phenomenology as well as other physical conditions that might be relevant such as cerebral palsy, scoloiosis, osteoporosis, etc. Results: Three examples where practice would have been improved by use of guidelines are given. Example 1; a young lady with osteoporosis and severe cerebral palsy whose seizures were characterised by adduction of the upper limbs and who was in a supportive wheelchair did not benefit from axillary generator placement as the seizure type prevented access for magnet stimulation, seizure movements ran the risk of bony injury and access was difficult for programming the generator. Example 2; a young man with severe scoliosis who wore a body brace had a subclavicular implant which prevented ready access for both magnet use and further programming. Example 3; a middle aged man had seizures that typically involved his arms being crossed and covering the area where the generator was subsequently implanted such that the access was impossible for magnet activation. Conclusions: Consideration of these issues would enable better use of magnet activation, optimum access for programming and system checks and minimise additional injury and discomfort.