Significant vomiting and weight loss in a pediatric epilepsy patient secondary to vagus nerve stimulation: A case report and review of the literature

被引:1
作者
Snyder, Hannah E. [1 ]
Pai, Nikhil [2 ,5 ]
Meaney, Brandon [1 ]
Birbeck, Cynthia Sloan [1 ]
Whitney, Robyn [1 ]
Johnson, Natasha [3 ]
Rosato, Laura [4 ]
Jones, Kevin [1 ]
机构
[1] McMaster Univ, Dept Pediat, Div Hematol, Hamilton, ON L8S 4K1, Canada
[2] McMaster Univ, Dept Pediat, Div Pediat Gastroenterol, Hamilton, ON L8S 4K1, Canada
[3] McMaster Univ, Dept Pediat, Div Adolescent Med, Hamilton, ON L8S 4K1, Canada
[4] St Josephs Healthcare Hamilton West 5th Campus, Dept Psychiat & Behav Neurosci, Div Child Psychiat, Hamilton, ON L8N 3K7, Canada
[5] McMaster Univ, Farncombe Family Digest Hlth Res Inst, Hamilton, ON L8S 4K1, Canada
关键词
Vagus nerve stimulation; Drug resistant epilepsy; Vomiting; Weight loss; Eating Disorder; CHILDREN;
D O I
10.1016/j.ebr.2023.100626
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Vagus nerve stimulation is a neuromodulatory treatment option for individuals with drug resistant epilepsy who are not resective surgical candidates. As the vagus nerve has widespread neural connections, stimulation can lead to an array of adverse effects. While vomiting and weight loss are known side effects of vagus nerve stimulation, these are typically transient, mild, and do not limit the ability to continue treatment. We describe a 17-year-old female with drug resistant focal epilepsy secondary to tuberous sclerosis complex, who began to experience daily emesis and significant weight loss approximately 2.5 years after VNS device insertion. Her body mass index progressively fell from between the 75th-85th percentiles to less than the first percentile. She underwent extensive workup by neurology, gastroenterology, and adolescent medicine services with no obvious cause identified. Prior to the insertion of an enteral tube for feeding support and urgent weight restoration, her vagus nerve stimulator was switched off, resulting in immediate cessation of her vomiting and a dramatically rapid recovery of weight over the ensuing few months. This case emphasizes the need to consider adverse effects of vagus nerve stimulation in the differential diagnosis of patients with otherwise unexplained new medical sequelae, and provides evidence potentially linking vagal stimulation to significant malnutrition-related complications. Outside of GI-related effects, few studies have shown late-onset adverse effects from VNS, including laryngeal and facial pain as well as bradyarrhythmia. Further research is needed to elucidate the exact mechanisms of vagus nerve stimulation to better anticipate and mitigate adverse effects, and to understand the pathophysiology of late-onset adverse effects in previously tolerant VNS patients.
引用
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页数:5
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