It was reported by the physician that the patient was uncomfortable with stimulation and he had requested how to perform diagnostic testing.It was later explained the patient was experiencing a shocking sensation with stimulation and the physician had decreased the pulse width and the frequency due to the shocking sensation.The patient was also sent for z-rays.One x-ray ap image, which included the neck and chest, was reviewed.The vns generator was in the left chest, the feedthru wires appeared intact, and the lead wires connector pin could not be fully assessed due to the image quality.A strain relief bend was present, but the presence of a strain relief loop could not be determined.While no sharp angles or gross lead fractures could be visualized due to image quality, there was a potential suspect location near the neck.An additional suspect area was noted above the generator and slightly above an additional lead for a device not associated with vns.However, it should be stated that it is unclear if the suspect areas actually show an issue with the lead, or if the suspect areas are just artifact.Additionally, proper electrode placement could not be determined due to image quality.The cause of the reported painful stimulation could not be conclusively determined.While there were no gross fractures or sharp angles conclusively observed in the image, a portion of the lead behind the generator could not be assessed; therefore, a lead fracture in that portion cannot be ruled out.The presence of a micro-fracture in the lead also cannot be ruled out.
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It was further explained by the physician that the patient¿s pain stopped when the device was programmed off; however, the patient experienced an increase in seizures due to the device disablement, so the device was programmed back on.The physician also mentioned high impedance was observed.Attempts for additional relevant information have been unsuccessful to date.
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