Sir, the recent article by Lisowska and Daly on vagus nerve stimulation therapy (VNST) (BDJ 2012; 212: 69–72) mentions pre-seizure auras being recognised in visual, auditory or olfactory systems.

This set me thinking because I have recently been asked to give orthodontic advice for a child who uses VNST, and who seems to experience his epileptic auras in the upper incisors.

Is the type of aura linked to the type of seizure inducing stimulus which an individual is sensitive to? For example are flashing lights more likely to cause fits in epileptic patients who have visual auras than other types of aura?

Might there be a risk that by applying a stimulus such as orthodontic forces to my patient's upper teeth, a seizure could be provoked?