Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing
Vagus nerve stimulation (VNS) can be a highly effective treatment option for patients with drug resistant epilepsy. Notably, VNS has demonstrated side effects including a unique form of sleep disordered breathing known as vagus nerve stimulator associated sleep disordered breathing (VaS). However, t...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | Epilepsy & Behavior Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589986425000383 |
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| author | Austin Sponaugle Rebecca S. Stainman Christopher M. Carosella |
| author_facet | Austin Sponaugle Rebecca S. Stainman Christopher M. Carosella |
| author_sort | Austin Sponaugle |
| collection | DOAJ |
| description | Vagus nerve stimulation (VNS) can be a highly effective treatment option for patients with drug resistant epilepsy. Notably, VNS has demonstrated side effects including a unique form of sleep disordered breathing known as vagus nerve stimulator associated sleep disordered breathing (VaS). However, the ways in which VaS interacts with seizure frequency is unknown. We report a case of a 28-year-old woman who presented to our department with complaints of worsening sleep quality 3 years following VNS implantation. Upon polysomnographic (PSG) evaluation, it was discovered that she suffered from VaS. The patient’s VNS output current was then down titrated during a subsequent PSG resulting in resolution of her VaS. Interestingly, despite downward titration of her nighttime VNS output current, the patient demonstrated a prolonged seizure free period, highlighting the complex interactions between VNS, VaS and seizure frequency. In cases where patients present with both epilepsy and VaS, physicians should be aware of this complex relationship. Further, this case highlights that down titration of VNS settings may result in not just improvement in VaS but may also result in improvement in seizure frequency. |
| format | Article |
| id | doaj-art-5382a9a00cf2460b8f21c8d190dc9eb9 |
| institution | DOAJ |
| issn | 2589-9864 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Epilepsy & Behavior Reports |
| spelling | doaj-art-5382a9a00cf2460b8f21c8d190dc9eb92025-08-20T03:09:17ZengElsevierEpilepsy & Behavior Reports2589-98642025-09-013110077810.1016/j.ebr.2025.100778Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathingAustin Sponaugle0Rebecca S. Stainman1Christopher M. Carosella2Department of Biology, Johns Hopkins University, Zanvyl Krieger School of Arts and Sciences, Baltimore, MD, United States; Department of Psychological and Brain Sciences, Johns Hopkins University, Zanvyl Krieger School of Arts and Sciences, Baltimore, MD, United StatesDivision of Neurology, Department of Pediatrics, Nemours Children’s Health, Wilmington, DE, United States; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA United StatesDepartment of Neurology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Corresponding author at: 707 N Broadway, Office 500, Baltimore, MD 21205, United States.Vagus nerve stimulation (VNS) can be a highly effective treatment option for patients with drug resistant epilepsy. Notably, VNS has demonstrated side effects including a unique form of sleep disordered breathing known as vagus nerve stimulator associated sleep disordered breathing (VaS). However, the ways in which VaS interacts with seizure frequency is unknown. We report a case of a 28-year-old woman who presented to our department with complaints of worsening sleep quality 3 years following VNS implantation. Upon polysomnographic (PSG) evaluation, it was discovered that she suffered from VaS. The patient’s VNS output current was then down titrated during a subsequent PSG resulting in resolution of her VaS. Interestingly, despite downward titration of her nighttime VNS output current, the patient demonstrated a prolonged seizure free period, highlighting the complex interactions between VNS, VaS and seizure frequency. In cases where patients present with both epilepsy and VaS, physicians should be aware of this complex relationship. Further, this case highlights that down titration of VNS settings may result in not just improvement in VaS but may also result in improvement in seizure frequency.http://www.sciencedirect.com/science/article/pii/S2589986425000383Sleep disordered breathingVagus Nerve StimulatorTitrationObstructive sleep apneaPolysomnographyIntractable generalized epilepsy |
| spellingShingle | Austin Sponaugle Rebecca S. Stainman Christopher M. Carosella Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing Epilepsy & Behavior Reports Sleep disordered breathing Vagus Nerve Stimulator Titration Obstructive sleep apnea Polysomnography Intractable generalized epilepsy |
| title | Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing |
| title_full | Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing |
| title_fullStr | Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing |
| title_full_unstemmed | Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing |
| title_short | Reduced VNS settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing |
| title_sort | reduced vns settings paradoxically decreases seizure burden in a patient following resolution of sleep disordered breathing |
| topic | Sleep disordered breathing Vagus Nerve Stimulator Titration Obstructive sleep apnea Polysomnography Intractable generalized epilepsy |
| url | http://www.sciencedirect.com/science/article/pii/S2589986425000383 |
| work_keys_str_mv | AT austinsponaugle reducedvnssettingsparadoxicallydecreasesseizureburdeninapatientfollowingresolutionofsleepdisorderedbreathing AT rebeccasstainman reducedvnssettingsparadoxicallydecreasesseizureburdeninapatientfollowingresolutionofsleepdisorderedbreathing AT christophermcarosella reducedvnssettingsparadoxicallydecreasesseizureburdeninapatientfollowingresolutionofsleepdisorderedbreathing |