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Abstract
The vagus nerve stimulator (VNS) has been used effectively for partial seizure disorders, however many patients suffer from side effects of alterations in voice. This case describes a new remediable adverse effect of the VNS. A patient with medically intractable epilepsy had improvement of his seizure control with VNS therapy after titrating him to a high output and rapid cycling paradigm with essentially no side effects. After a battery replacement, he was restarted on his previous settings and subsequently developed a hoarse voice. He was found to have complete left vocal cord paralysis, an adverse effect attributed to a rapid titration to his previous high output and rapid cycling paradigm. This side effect has not been previously described in the literature. The patient subsequently had a medialization thyroplasty with resolution of his hoarse voice.