Vagus Nerve Stimulation for Epilepsy

Written by Kristeen Cherney | Published on July 11, 2014
Medically Reviewed by George T. Krucik, MD, MBA on July 11, 2014

Overview

Vagus Nerve Stimulation (VNS) has gained attention over the last decade as a potential treatment for epilepsy. The U.S. Food and Drug Administration approved it in 1997 for select patients. While VNS is widely considered a complementary treatment, it may help patients who do not respond to anti-seizure medications.

This therapy brings hope to patients who cannot have brain surgery. VNS has great potential in the world of epilepsy treatment, but there are still risks involved. Learn more and ask your doctor if you’re a candidate for this form of epilepsy therapy.

How Does VNS Work?

VNS targets the vagus nerve to reduce the severity and frequency of epileptic seizures. Also called the cranial nerve X, it’s located along the:

  • neck
  • brain
  • chest
  • stomach

The vagus nerve is the longest cranial nerve in the body and has multiple functions. Through VNS, the hope is that nerve stimulation can flow up to the brain to control seizures. An electrical device is surgically placed into the chest with a wire that extends to the vagus nerve. The device sends pulses through the neck when activated. According to NYU Langone Medical Center, a VNS device is 6 centimeters wide. This is about the size of a pacemaker.

Seizure control through VNS is not a continuous process. Your doctor programs the device during surgery for a set frequency. You might receive pulses more often if you have frequent seizures. Your doctor can increase the rate if necessary. Wave a magnetic wand in front of the VNS device to activate it. Ideally, you should activate the device as soon as you feel a seizure coming on. This will help you prepare for epilepsy symptoms before they start. The magnetic wand also gives you the ability to turn off the VNS device as needed.  

VNS surgery itself is minor and it takes only a couple of hours to implant the device. Most epilepsy patients go home the same day.

Eligibility Factors

VNS is specifically designed for patients with refractory partial epilepsy. This means that the seizures are severe and frequent. Due to potential benefits and effectiveness, some neurologists are expanding the procedure for the treatment of generalized epilepsies.

Other factors determine a patient’s eligibility for VNS. Patients must:

  • be 12 years of age or older
  • have either refractory partial epilepsy or refractory depression
  • have a history of unsuccessful attempts with medication
  • not be eligible for epilepsy brain surgery

Potential Benefits and Efficacy

VNS has potential. Review the specific benefits and rates of efficacy with your doctor before committing to this treatment. The Journal of the American Academy of Neurology reports that over half of epilepsy patients experience at least a 50 percent improvement in seizures. It can take a year or longer to experience these types of results.

While many patients experience the benefit of fewer, less severe seizures, one-third of patients don’t notice any difference. NYU Langone Medical Center reports that only 5 percent of all patients become seizure-free. The goal of VNS is to improve quality of life, and most patients succeed with this type of treatment.

VNS Side Effects

Despite the potential benefits, VNS also has a few drawbacks. Patients might have difficulties with:

  • sleeping
  • swallowing (when device is on)
  • speaking (especially when the device is activated)
  • metal detectors

In rare cases, VNS can cause breathing difficulties or cardiovascular problems. Call your doctor if have any issues right after stimulations. Decreasing the strength and frequency of VNS pulses can reduce risk factors.

Outlook

Epilepsy has no cure and is only managed with the help of treatment measures. VNS itself is not a cure-all. It’s one form of treatment that can reduce your symptoms. Many patients rely on VNS alone for epilepsy, while others use it alongside medications. Currently, this approach is primarily used in adults. As doctors assess the safety and efficacy VNS may eventually be widely used in young children.

VNS is unlikely to make your symptoms worse, but the surgery is not a one-time event. According to NYU Langone Medical Center, VNS devices last about five years. Most patients choose to have surgery again for a replacement device when the battery dies. Consider other epilepsy treatment options first if you don’t wish to undergo surgery every few years.

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