Management of Vagus Nerve Stimulation–Related Complications in Drug Resistant Epilepsy: A System-Based Review Publisher



Alvani MS ; Biazar BH ; Fallah M ; Dehnavi NS ; Mehmandoost M ; Bahri A ; Yousefi H ; Bagheri K ; Akbarzadehi D ; Zali A ; Fahim F
Source: Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Published:2026

Abstract

Background: Vagus nerve stimulation (VNS) is an established adjunct for drug-resistant epilepsy (DRE), yet its “wandering” effects across organ systems generate a wide range of adverse events. Objective: To collate published VNS-related complications and present pragmatic, system-based management guidance. Methods: PubMed, Scopus, and Web of Science were searched from inception to 30 June 2025 for human studies reporting surgical, device-related, or stimulation-linked problems after cervical VNS in DRE or treatment-resistant depression. Two reviewers independently screened, extracted, and synthesised data in this narrative review. Results: Airway sequelae—hoarseness, cough, dyspnoea, stridor and sleep apnoea—were the most typical reactions; most resolved after reducing output current, pulse width or duty-cycle, or by magnet-controlled pauses. Device failures comprised lead fracture (up to 11.9 % in paediatric cohorts), generator battery depletion prompting replacement in 15–27 % of long-term users, and infections in 2–6 % of implants. Rare but serious cardiac events—bradycardia or intra-operative asystole (manufacturer estimate 0.1–1 %)—were reversible when stimulation ceased. Isolated neurological, psychiatric, and gastrointestinal events (pain, tremor, mania, intractable hiccups, diarrhoea) were typically mitigated by parameter adjustment or explantation. Conclusions: Roughly half of DRE patients attain ≥50 % seizure reduction with VNS, but durable benefit hinges on vigilant, system-specific surveillance and early tailored interventions. A structured, organ-oriented approach helps multidisciplinary teams balance seizure control, safety, and quality of life throughout the device's lifespan. © 2026 The Author(s)