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McGrath H, Pennington Z, Cross MR, Hoffman EM, Gregg NM, Tasche KK, Bayan SL, Van Gompel JJ. Delayed vagal nerve compressive neuropathy following placement of vagal nerve stimulator: case report. Acta Neurochir (Wien) 2024; 166:193. [PMID: 38662025 DOI: 10.1007/s00701-024-06087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Vagal neuropathy causing vocal fold palsy is an uncommon complication of vagal nerve stimulator (VNS) placement. It may be associated with intraoperative nerve injury or with device stimulation. Here we present the first case of delayed, compressive vagal neuropathy associated with VNS coil placement which presented with progressive hoarseness and vocal cord paralysis. Coil removal and vagal neurolysis was performed to relieve the compression. Larger 3 mm VNS coils were placed for continuation of therapy. Coils with a larger inner diameter should be employed where possible to prevent this complication. The frequency of VNS-associated vagal nerve compression may warrant further investigation.
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Affiliation(s)
- Hari McGrath
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Zach Pennington
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | | | | | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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2
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Behnke J, Miller Z, Turner M, McChesney J. Laryngeal myoclonus related to vagal nerve stimulation. EAR, NOSE & THROAT JOURNAL 2022:1455613221116987. [PMID: 35969486 DOI: 10.1177/01455613221116987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- John Behnke
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Zachary Miller
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Meghan Turner
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Jason McChesney
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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3
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Nguyen TK, Yadav S, Truong TA, Han M, Barton M, Leitch M, Guzman P, Dinh T, Ashok A, Vu H, Dau V, Haasmann D, Chen L, Park Y, Do TN, Yamauchi Y, Rogers JA, Nguyen NT, Phan HP. Integrated, Transparent Silicon Carbide Electronics and Sensors for Radio Frequency Biomedical Therapy. ACS NANO 2022; 16:10890-10903. [PMID: 35816450 PMCID: PMC9332346 DOI: 10.1021/acsnano.2c03188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The integration of micro- and nanoelectronics into or onto biomedical devices can facilitate advanced diagnostics and treatments of digestive disorders, cardiovascular diseases, and cancers. Recent developments in gastrointestinal endoscopy and balloon catheter technologies introduce promising paths for minimally invasive surgeries to treat these diseases. However, current therapeutic endoscopy systems fail to meet requirements in multifunctionality, biocompatibility, and safety, particularly when integrated with bioelectronic devices. Here, we report materials, device designs, and assembly schemes for transparent and stable cubic silicon carbide (3C-SiC)-based bioelectronic systems that facilitate tissue ablation, with the capability for integration onto the tips of endoscopes. The excellent optical transparency of SiC-on-glass (SoG) allows for direct observation of areas of interest, with superior electronic functionalities that enable multiple biological sensing and stimulation capabilities to assist in electrical-based ablation procedures. Experimental studies on phantom, vegetable, and animal tissues demonstrated relatively short treatment times and low electric field required for effective lesion removal using our SoG bioelectronic system. In vivo experiments on an animal model were conducted to explore the versatility of SoG electrodes for peripheral nerve stimulation, showing an exciting possibility for the therapy of neural disorders through electrical excitation. The multifunctional features of SoG integrated devices indicate their high potential for minimally invasive, cost-effective, and outcome-enhanced surgical tools, across a wide range of biomedical applications.
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Affiliation(s)
- Tuan-Khoa Nguyen
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Sharda Yadav
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Thanh-An Truong
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
- School
of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Mengdi Han
- Department
of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
| | - Matthew Barton
- School
of Nursing and Midwifery, Griffith University, Brisbane, Queensland 4111, Australia
- Menzies
Health Institute Queensland, Brisbane, Queensland 4222, Australia
| | - Michael Leitch
- School
of Nursing and Midwifery, Griffith University, Brisbane, Queensland 4111, Australia
| | - Pablo Guzman
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Toan Dinh
- Centre
for Future Materials, University of Southern
Queensland, Toowoomba, Queensland 4305, Australia
| | - Aditya Ashok
- Australian
Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Hieu Vu
- School
of Engineering and Built Environment, Griffith
University, Brisbane, Queensland 4215, Australia
| | - Van Dau
- School
of Engineering and Built Environment, Griffith
University, Brisbane, Queensland 4215, Australia
| | - Daniel Haasmann
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Lin Chen
- State
Key Laboratory for Mechanical Behavior of Materials, School of Materials
Science and Engineering, Xi’an Jiaotong
University, Xi’an 710049, Shaanxi, People’s Republic of China
| | - Yoonseok Park
- Querrey
Simpson Institute for Bioelectronics, Northwestern
University, Evanston, Illinois 60208, United States
- Department
of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Yongin 17104, Republic
of Korea
| | - Thanh Nho Do
- Graduate
School of Biomedical Engineering, The University
of New South Wales, Sydney, New South Wales 2032, Australia
| | - Yusuke Yamauchi
- Australian
Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
- JST-ERATO
Yamauchi Materials Space-Tectonics Project, Kagami Memorial Research
Institute for Science and Technology, Waseda
University, Tokyo 169-0051, Japan
| | - John A. Rogers
- Querrey
Simpson Institute for Bioelectronics, Northwestern
University, Evanston, Illinois 60208, United States
- Department
of Materials Science and Engineering, Department of Mechanical Engineering,
Department of Biomedical Engineering, Departments of Electrical and
Computer Engineering and Chemistry, and Department of Neurological
Surgery, Northwestern University, Evanston, Illinois 60208, United States
| | - Nam-Trung Nguyen
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Hoang-Phuong Phan
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
- School
of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales 2052, Australia
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4
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Tami A, Gerges D, Herrington H. Stridor Related to Vagus Nerve Stimulator: A Case Report. Laryngoscope 2020; 131:E1733-E1734. [PMID: 33009823 DOI: 10.1002/lary.29144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 11/08/2022]
Abstract
Implantation of a vagus nerve stimulator (VNS) can be an effective treatment for medically refractory seizures. Laryngeal side effects from a VNS can include hoarseness, cough, and shortness of breath. This report highlights a 5-year-old female who presented with stridor in the setting of acquired laryngomalacia, global developmental delay, and a VNS device. The case demonstrates that a VNS can exacerbate the symptoms of acquired laryngomalacia and that close monitoring of laryngeal side effects is crucial to optimizing care in this population. Laryngoscope, 131:E1733-E1734, 2021.
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Affiliation(s)
- Abigail Tami
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Daniel Gerges
- University of Vermont Medical Center, Burlington, Vermont, U.S.A.,University of Vermont Larner College of Medicine, Burlington, Vermont, U.S.A
| | - Heather Herrington
- University of Vermont Medical Center, Burlington, Vermont, U.S.A.,University of Vermont Larner College of Medicine, Burlington, Vermont, U.S.A
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5
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Vocal Outcomes in Vagus Nerve Stimulation: A Laryngeal Pattern-Based Objective Analysis. J Voice 2020; 36:719-725. [DOI: 10.1016/j.jvoice.2020.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
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6
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Castellani L, Chiesa V, Maccari A, Fuccillo E, Canevini MP, Felisati G, Saibene AM. Pharyngolaryngeal spasm-induced dysphagia in an epileptic patient undergoing vagus nerve stimulation therapy. Clin Case Rep 2020; 8:858-861. [PMID: 32477534 PMCID: PMC7250986 DOI: 10.1002/ccr3.2761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 11/08/2022] Open
Abstract
Vagus nerve stimulation for refractory epilepsy may induce laryngeal side effects such as dysphonia and dysphagia. Careful tuning of the stimulation parameters and collaboration between epileptologists and otolaryngologists can help significantly reduce side effects.
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Affiliation(s)
- Luca Castellani
- Otolaryngology UnitASST Santi Paolo e CarloDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Valentina Chiesa
- Regional Centre for EpilepsyASST Santi Paolo e CarloDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Alberto Maccari
- Otolaryngology UnitASST Santi Paolo e CarloDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Emanuela Fuccillo
- Institute of OtorhinolaryngologyDepartment of Clinical Sciences and Translation MedicineUniversità di Roma Tor VergataRomeItaly
| | - Maria Paola Canevini
- Regional Centre for EpilepsyASST Santi Paolo e CarloDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Giovanni Felisati
- Otolaryngology UnitASST Santi Paolo e CarloDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Alberto Maria Saibene
- Otolaryngology UnitASST Santi Paolo e CarloDepartment of Health SciencesUniversità degli Studi di MilanoMilanItaly
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7
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Beckelhymer LM, Fink DS, Litts JK. Behavioral Management of Laryngeal Complaints Caused by Vagal Nerve Stimulation for Medically Refractory Epilepsy. J Voice 2020; 35:651-654. [PMID: 31889648 DOI: 10.1016/j.jvoice.2019.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study investigated behavioral management of dysphonia and laryngeal dyspnea secondary to use of vagal nerve stimulation (VNS) in an individual with medically refractory epilepsy. STUDY DESIGN Retrospective chart review. METHODS Medical records from a single patient were reviewed. The patient received treatment with the speech-language pathologist (SLP) and laryngologist to observe patterns of laryngeal hyperfunction using biofeedback, and treatment with the SLP to learn to perform rescue breathing techniques, relaxation techniques, and awareness of muscle tension to aid the control of symptoms during activation. Data collected included neurology and laryngology notes. Neurology notes were used to track VNS settings, tolerance, and incidence of seizures. Laryngology notes included documentation of diagnosis, treatment, and measures of patient perception of severity (ie, Voice Handicap Index, Dyspnea Index, Cough Severity Index). RESULTS Prior to treatment, the patient was unable to receive benefits from VNS due to severe laryngeal adverse effects, such that the device remained off for eight months postimplantation. Following treatment, the patient effectively managed laryngeal side effects and was able to tolerate increases in VNS output current, signal frequency, and duration. CONCLUSIONS Voice therapy was effective in managing changes in vocal fold mobility and laryngeal tension. As the number of individuals receiving VNS for epilepsy and inflammatory conditions increases, the SLP and laryngologist may play a key role in interdisciplinary management of laryngeal side effects secondary to vagal nerve stimulation.
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Affiliation(s)
| | - Daniel S Fink
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Juliana K Litts
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.
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Vespa S, Stumpp L, Bouckaert C, Delbeke J, Smets H, Cury J, Ferrao Santos S, Rooijakkers H, Nonclercq A, Raedt R, Vonck K, El Tahry R. Vagus Nerve Stimulation-Induced Laryngeal Motor Evoked Potentials: A Possible Biomarker of Effective Nerve Activation. Front Neurosci 2019; 13:880. [PMID: 31507360 PMCID: PMC6718640 DOI: 10.3389/fnins.2019.00880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Vagus nerve stimulation (VNS) therapy is associated with laryngeal muscle activation and induces voice modifications, well-known side effects of the therapy resulting from co-activation of the recurrent laryngeal nerve. In this study, we describe the non-invasive transcutaneous recording of laryngeal motor evoked potentials (LMEPs), which could serve as a biomarker of effective nerve activation and individual titration in patients with drug-resistant epilepsy. We recruited drug-resistant epileptic patients treated for at least 6 months with a VNS. Trains of 600-1200 VNS pulses were delivered with increasing current outputs. We placed six skin electrodes on the ventral surface of the neck, in order to record LMEPs whenever the laryngeal muscular threshold was reached. We studied the internal consistency and the variability of LMEP recordings, and compared different methods for amplitude calculation. Recruitment curves were built based on the stimulus-response relationship. We also determined the electrical axis of the LMEPs dipole in order to define the optimal electrode placement for LMEPs recording in a clinical setting. LMEPs were successfully recorded in 11/11 patients. The LMEPs threshold ranged from 0.25 to 1 mA (median 0.50 mA), and onset latency was between 5.37 and 8.77 ms. The signal-to-noise ratio was outstanding in 10/11 patients. In these cases, excellent reliability (Intraclass correlation coefficient, ICC > 0.90 across three different amplitude measurements) was achieved with 10 sample averages. Moreover, our recordings showed very good internal consistency (Cronbach's alpha > 0.95 for 10 epochs). Area-under-the-curve and peak-to-peak measurement proved to be complementary methods for amplitude calculation. Finally, we determined that an optimal derivation requires only two recording electrodes, aligned on a horizontal axis around the laryngeal prominence. In conclusion, we describe here an optimal methodology for the recording of VNS-induced motor evoked responses from the larynx. Although further clinical validation is still necessary, LMEPs might be useful as a non-invasive marker of effective nerve activation, and as an aid for the clinician to perform a more rational titration of VNS parameters.
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Affiliation(s)
- Simone Vespa
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Lars Stumpp
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Jean Delbeke
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Hugo Smets
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Joaquin Cury
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Susana Ferrao Santos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Herbert Rooijakkers
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Robrecht Raedt
- 4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium
| | - Kristl Vonck
- 4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium.,Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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9
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Vaiman M, Heyman E, Lotan G. Neurological results of the modified treatment of epilepsy by stimulation of the vagus nerve. Childs Nerv Syst 2017; 33:2017-2022. [PMID: 28689344 DOI: 10.1007/s00381-017-3490-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The vagus nerve stimulation (VNS) is used for treatment of drug-resistant epilepsy but laryngeal side effects are common. We tried to improve VNS by modifying the implantation procedure. The aim was to reduce the rate of side effects that have prevented using VNS to its full capacity. METHODS We operated on 74 pediatric patients for VNS device implantation using a modified surgical protocol incorporating lower neck incision for electrode placement and 36 patients who were operated by standard technique were used for control group. We retrospectively analyzed reduction in frequency of seizures, reduction in severity of seizures (assessed by the shortened Ictal/post-ictal subscale of the Liverpool Seizure Severity Scale that included falling to the ground, postictal headache and sleepiness, incontinence, tongue biting, and injury during attack). RESULTS Using the new implantation technique, side effects related directly to VNS therapy occurred in six cases (8.1%) showing statistically sound improvement over the standard implantation technique (p ˂ 0.05). To achieve good results, the maximum stimulation (3.5 mA) was used in 24 patients (32.4%), with no laryngeal side effects detected. Twelve patients (16.2%) were seizure-free after the first year of VNS treatment. 74.3% of patients experienced a 50% reduction in seizure frequency and improved ictal or postictal activity. CONCLUSION To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique may be modified, and lower neck incision could be used. A low rate of laryngeal side effects allows using the VNS device to its full electrical capacity.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 33 Shapiro Street, 59561, Bat Yam, Israel.
| | - Eli Heyman
- Pediatric Epilepsy Service, Pediatric Neurology Department, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Lotan
- Department of Pediatric Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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The role of laryngeal electromyography in vagus nerve stimulation-related vocal fold dysmotility. Eur Arch Otorhinolaryngol 2016; 274:1585-1589. [DOI: 10.1007/s00405-016-4344-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/07/2016] [Indexed: 12/18/2022]
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11
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Zambrelli E, Saibene AM, Furia F, Chiesa V, Vignoli A, Pipolo C, Felisati G, Canevini MP. Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy. Epilepsia 2015; 57:e24-7. [DOI: 10.1111/epi.13252] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center; San Paolo Hospital; Milan Italy
| | - Alberto M. Saibene
- Department of Otolaryngology; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
| | - Francesca Furia
- Epilepsy Center - Sleep Medicine Center; San Paolo Hospital; Milan Italy
| | - Valentina Chiesa
- Epilepsy Center - Sleep Medicine Center; San Paolo Hospital; Milan Italy
| | - Aglaia Vignoli
- Epilepsy Center - Sleep Medicine Center; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
| | - Carlotta Pipolo
- Department of Otolaryngology; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
| | - Giovanni Felisati
- Department of Otolaryngology; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center - Sleep Medicine Center; San Paolo Hospital; Milan Italy
- Department of Health Sciences; University of Milan; Milan Italy
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12
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Van Lierde K, Kryshtopava M, Gadeyne S, Luyten A, D'haeseleer E, Bruneel L, Van Maele G, Boehme B, Piens N, Vonck K. Impact of Vagal Nerve Stimulation on Objective Vocal Quality, a Pilot Study. J Voice 2015; 29:777.e9-15. [PMID: 25795351 DOI: 10.1016/j.jvoice.2015.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/30/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the impact of vagal nerve stimulation (VNS) on the vocal quality using the dysphonia severity index (DSI). It was hypothesized that the objective vocal quality and other vocal characteristics are disordered in comparison with an age- and gender-matched control group. In addition, the acoustic vocal parameters were compared during three conditions: at rest, during normal stimulation, and raised stimulation. A significant relation between the amount of stimulation and the presence of disturbed acoustic parameters was hypothesized. METHODS Subjective (auditory-perceptual evaluation and voice handicap index) and objective (aerodynamic, vocal range, acoustic measurements and determination of the DSI) measurements were used to determine the vocal quality in 13 subjects with VNS in three different conditions (at rest and during normal and raised stimulation) and the age- and gender-matched control group. RESULTS The subjects with VNS had a disordered perceptual vocal quality mainly characterized by the presence of a moderate roughness and slight breathiness, and the objective vocal quality by means of the DSI value is -2.4. During stimulation and especially during raised stimulation, the fundamental frequency is significantly increased. However, the subjects experienced no psychosocial handicapping effect of the vocal quality on the quality of life. CONCLUSIONS Subjects with VNS have typical vocal characteristics. Ear, nose, and throat specialists and voice therapist must be aware of the presence of this vocal pattern at rest and during normal and raised stimulation. Especially, professional voice users and elite vocal performers must be informed before implantation.
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Affiliation(s)
- Kristiane Van Lierde
- Department of Speech, Language, and Hearing Sciences, Ghent University, Gent, Belgium.
| | - Marina Kryshtopava
- Department of Ear, Nose, and Throat and Head and Neck Surgery, Ghent University, Gent, Belgium
| | - Stefanie Gadeyne
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University, Gent, Belgium
| | - Anke Luyten
- Department of Speech, Language, and Hearing Sciences, Ghent University, Gent, Belgium
| | - Evelien D'haeseleer
- Department of Speech, Language, and Hearing Sciences, Ghent University, Gent, Belgium
| | - Laura Bruneel
- Department of Speech, Language, and Hearing Sciences, Ghent University, Gent, Belgium
| | | | - Beatrijs Boehme
- Department of Speech, Language, and Hearing Sciences, Ghent University, Gent, Belgium
| | - Nina Piens
- Department of Speech, Language, and Hearing Sciences, Ghent University, Gent, Belgium
| | - Kristl Vonck
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University, Gent, Belgium
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13
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Felisati G, Saibene AM, Canevini MP. In reference toTreatment of epilepsy by stimulation of the vagus nerve from head-and-neck surgical point of view. Laryngoscope 2015; 125:E326. [DOI: 10.1002/lary.25131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Giovanni Felisati
- Department of Otolaryngology, San Paolo Hospital; University of Milan; Milan Italy
| | | | - Maria Paola Canevini
- Department of Neurology, Regional Centre for Epilepsy, San Paolo Hospital; University of Milan; Milan Italy
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14
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Lotan G, Vaiman M. Treatment of epilepsy by stimulation of the vagus nerve from Head-and-Neck surgical point of view. Laryngoscope 2014; 125:1352-5. [PMID: 25429912 DOI: 10.1002/lary.25064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The current article is dedicated to the surgical aspect of the vagus nerve stimulation (VNS) and our efforts to improve the surgical technique. The aim was to reduce the side effect/surgical complication rate as well as the time needed for this surgery. STUDY DESIGN A case series. METHODS The surgical data of 72 consecutive patients (age 4-14) who were operated for VNS device implantation from 2007 to 2014 were collected and analyzed. We designed the new surgical protocol that was implemented in all 72 cases and analyzed postsurgical side effects/complication rates. This protocol suggests low neck incision, detecting the vagus between the heads of the sternocleidomastoid muscle, a submuscular pocket for the device, and a short tunnel between it and the vagus electrodes. RESULTS The implantation took about 40 minutes; 4.2% of the patients (n = 3) were afflicted by complications related to surgery; and one patient (1.4%) suffered from hardware malfunctions. Side effects related to VNS therapy itself occurred in seven cases (6.9%). CONCLUSION To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique should be significantly modified, and lower neck incision could be implemented together with a submuscular pocket for the battery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Gad Lotan
- Department of Pediatric Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michael Vaiman
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
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