Safe Simultaneous Use of Sacral Neuromodulation and Vagal Nerve Stimulation.

Introduction: The potential for costimulation with competitive effects between implanted electronic devices remains speculative both at the level at the implanted device and with active programming but also at the retrograde site of action. We present a patient with an implanted vagal nerve stimulator for refractory epilepsy who underwent successful staged sacral neuromodulation (SNS) and benefits from both technologies.

Case: This is a case report of a 42-year-old female patient with a history notable for medically intractable epilepsy, temporal lobectomy, and vagal nerve stimulation who subsequently underwent staged SNS for refractory overactive bladder syndrome. The patient continues to benefit from sustained reduction in her bladder issues and without dimunition of her seizure threshold at 6-month follow-up.

Discussion: Different action sites for SNS as well as vagal nerve stimulation are possible. The role of the thalamus in continence and seizure activity is reviewed. There does not seem to be an interactive effect during the simultaneous use of these 2 modalities.