PDF(Sci-hub)
Abstract：
Vagus nerve stimulation (VNS) is often used for patients with drug-resistant epilepsy. Although this intervention may improve seizure control and mood, a number of factors must be considered when patients with VNS near end of life. We reviewed relevant literature to create a proposed guideline for management of patients with VNS in palliative care and after death. VNS has multiple possible side effects, including cough and swallowing difficulties. For patients with neurologic disease in palliative care, such adverse effects can severely affect quality of life and increase the risk for complications such as aspiration pneumonia. Patients with VNS should be screened regularly for such side effects, and VNS parameters should be adjusted if they are identified. If a patient requires urgent cardiac resuscitation involving external defibrillation, the VNS should be interrogated immediately afterwards to evaluate its function. During defibrillation, paddles should be placed perpendicular to the VNS, and as far as possible away from it. The VNS can be acutely turned off by taping the magnet to the patient\'s chest, thereby preventing any possible interference with restoration of a normal heart rhythm. After death, any staff involved with handling the body should be notified that a VNS is in place. The device must be removed prior to cremation, as it can explode with high heat. If the cause of death is unclear, a full postmortem examination should be undertaken, per sudden unexpected death in epilepsy guidelines. If there is concern about device malfunction, the device should be returned to the manufacturer for evaluation.
摘要：
迷走神经刺激（VNS）通常用于耐药性癫痫患者。虽然这种干预可以改善癫痫发作控制和情绪，当VNS患者接近生命终点时，必须考虑许多因素。我们回顾了相关文献，以制定姑息治疗和死亡后VNS患者的治疗指南。VNS有多种可能的副作用，包括咳嗽和吞咽困难。对于接受姑息治疗的神经系统疾病患者，这种不良反应会严重影响生活质量，并增加吸入性肺炎等并发症的风险。VNS患者应定期筛查此类副作用，和VNS参数应调整，如果他们被识别。如果患者需要涉及外部除颤的紧急心脏复苏，之后应立即询问VNS以评估其功能。除颤期间,桨应该垂直于VNS放置，尽可能远离它。通过将磁铁贴在患者的胸部，可以急剧关闭VNS，从而防止任何可能的干扰恢复正常的心律。死后,任何参与处理身体的工作人员都应被告知VNS已经到位。火葬前必须移除该装置，因为它可以在高温下爆炸。如果死因不清楚,应该进行全面的尸检，根据癫痫指南中的突发性意外死亡。如果担心设备故障，设备应返回制造商进行评估。
