{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T10:02:18Z","timestamp":1769767338755,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T00:00:00Z","timestamp":1590624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Vagus nerve stimulation (VNS) is often used for patients with drug\u2010resistant 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.<\/jats:p>","DOI":"10.1111\/epi.16553","type":"journal-article","created":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T11:26:12Z","timestamp":1590665172000},"page":"1336-1340","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A proposed guideline for vagus nerve stimulator handling in palliative care and after death"],"prefix":"10.1111","volume":"61","author":[{"given":"Ghadd","family":"Alhajaj","sequence":"first","affiliation":[{"name":"Division of Neurology Department of Pediatrics Montreal Children\u2019s Hospital McGill University Health Centre Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1793-2536","authenticated-orcid":false,"given":"Jeffrey","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery Montreal Children's Hospital McGill University Health Centre Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2807-7347","authenticated-orcid":false,"given":"Mark R.","family":"Keezer","sequence":"additional","affiliation":[{"name":"Department of Neurosciences University of Montreal Montreal QC Canada"},{"name":"Research Centre of the University of Montreal Hospital Centre Montreal QC Canada"},{"name":"Department of Social and Preventive Medicine University of Montreal Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Nikolic","sequence":"additional","affiliation":[{"name":"Clark Smith Brain Tumour Centre Charbonneau Cancer Institute University of Calgary Calgary AB Canada"},{"name":"Alberta Children's Hospital Research Institute University of Calgary Calgary AB Canada"},{"name":"Department of Biochemistry and Molecular Biology Cumming School of Medicine University of Calgary Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7831-4593","authenticated-orcid":false,"given":"Kenneth A.","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Neurology Department of Pediatrics Montreal Children\u2019s Hospital McGill University Health Centre Montreal QC Canada"},{"name":"Department of Neurology and Neurosurgery Montreal Children's Hospital McGill University Health Centre Montreal QC Canada"},{"name":"Research Institute of the McGill University Medical Centre Montreal QC 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