Abstracts

To inform the epilepsy community that right-sided vagus nerve stimulation is an option in refractory epilepsy patients who cannot have a left-sided vagus nerve stimulator.
We describe two patients with right-sided vagus nerve stimulators implanted for treatment of intractable seizures.
Our first patient has symptomatic mixed generalized seizures and hypotonic cerebral palsy presumably due to in utero drug exposure. He had a left-sided vagus nerve stimulator (VNS) removed three times due to skin breakdown and infections, resulting in six surgeries on the left side. Our second patient has absence, complex partial, and generalized tonic seizures. He had three surgeries on the left side due to infections and a fractured lead wire. Both patients had dramatic improvement in seizure control (one seizure free, the other over 90% decrease in seizures) with left-sided VNS. Both patients previously had daily seizures. It was not felt that the left vagus nerve could be re-approached surgically. Each patient had a right-sided vagus nerve stimulator implanted. The first has had a right-sided VNS for over one year, and the second had a right-sided VNS implanted four months ago. They have had no bradycardia or other cardiac problems, and the first has been seizure-free for over one year off antiepileptic medication. The second patient has developed reactive airway changes which are being evaluated.
Right-sided VNS may be an option if a patient had significant benefit from prior vagus nerve stimulation but is unable to have a left-sided VNS.