Externalization of an infected vagus nerve stimulator generator without a break in anti-seizure therapy: a technical note

Introduction: Vagus nerve stimulation (VNS) is a widely used treatment for drug-resistant epilepsy. An infection of the VNS generator pocket occurs in 3-8% of cases. Current standard of care requires the removal of the device, antibiotic therapy, and then replacement of the device. The consequential break in VNS therapy leaves patients highly susceptible to seizures.

Methods: Retrospective case report.

Results: The externalized generator continued to provide electroceutical coverage of the patient's seizures while the pocket was sterilized with IV antibiotics as well as betadine and local antibiotics. The externalized generator was kept safe against the patient's chest with ioban and an entriely new system was implanted on post-externalization day 5. The patient is now 7 months post-operative and without any evidence of infection.

Conclusions: We report successful management of an infected VNS generator with externalization and short interval replacement of the entire system without any break in anti-seizure therapy.