Deactivation of a Right-Sided Vagus Nerve Stimulator due to Cardiac Side Effects: Case Report

Background: Stimulation of the left vagus nerve is a well-established therapy for patients with drug-resistant epilepsy who are not candidates for resective or disconnection surgery. Right-sided vagus nerve stimulation is generally avoided due to concerns about serious cardiac side effects, as the right vagus nerve is anatomically associated with the innervation of the sinoatrial node. Only a few cases of right-sided vagus nerve stimulation in drug-resistant epilepsy have been reported to date. Materials and Methods: An 8-year-old child with drug-resistant epilepsy and a left-sided Port-a-Cath positioned in the left internal jugular vein underwent uneventful insertion of a right-sided vagus nerve stimulator device. Results: The vagus nerve stimulator was deactivated due to postoperative cardiac side effects, which subsequently resolved. Conclusion: We report the first case of a child with drug resistant epilepsy in whom a right-sided vagus nerve stimulator was deactivated due to postoperative cardiac effects. Nonetheless, right-sided implantation may be a viable therapeutic option when left-sided implantation is contraindicated, provided careful cardiac monitoring and individualized risk-benefit analysis are undertaken.