Abstracts

The vagus nerve stimulator was FDA approved in 1997 and has become a standard modality for intractable pediatric epilepsy. We reviewed our experience for major adverse events, following an accidental puncture of a VNS wire by an emergency room physician seeking intravenous access for status epilepticus. Review of CNMC VNS experience for patient characteristics, duration of VNS therapy, and clinically significant, treatment limiting adverse events. Since 1998, 51 patients have had VNS implantation at CNMC. The median age at implant was 11 years (age range 37 months [ndash] 24 yrs). The duration of VNS therapy was 39 months (mean), range: 2-86 months. A total of 14 (27 %) patients had clinically significant adverse events. Adverse events were: prominent drooling (in 6), coughing (4), dysphagia (1), difficulty breathing (2; 1 leading to explantation); wound infection (2; 1 requiring explantation), vomiting when device was delivering current (2). Output current settings were limited in all of the above with the exception of 1 of 2 infection cases (stitch abscess). There were two deaths in the cohort (unrelated to VNS). One 13 year old boy presented to an outlying emergency department for status epilepticus, and the VNS line was pierced in search of IV access. Subsequent interrogation and electrode testing revealed no stimulator dysfunction or abnormal electrode impedance. VNS has been relatively well tolerated in our pediatric epilepsy program. The most common and clinically limiting signs of nontolerance are drooling and cough. Patients and families should be made aware of the potential for misidentification of the VNS wire for intravenous access in an emergency medical setting.