Many people living with epilepsy try several different seizure medications with varying degrees of success. Research shows that the chances of becoming seizure-free decrease with each successive new drug regimen.

If you’ve already been prescribed two or more epilepsy medications without success, you may want to explore non-drug therapies. One option is vagus nerve stimulation (VNS). This option has been shown to significantly lessen the frequency of seizures in people with epilepsy.

Here’s a brief overview of the basics to help you decide whether VNS could be right for you.

What it does

VNS uses a small device implanted into your chest to send pulses of electrical energy to your brain through the vagus nerve. The vagus nerve is a cranial nerve pair connected to the motor and sensory functions in your sinuses and esophagus.

VNS raises your neurotransmitter levels and stimulates certain areas of the brain involved in seizures. This can help decrease the recurrence and severity of your seizures and generally improve your quality of life.

How it’s implanted

Implanting a VNS device involves a short surgical procedure, usually lasting 45 to 90 minutes. A qualified surgeon performs the procedure.

During the procedure, a small incision is made on the upper left side of your chest where the pulse-generating device will be implanted.

A second incision is then be made on the left side of your lower neck. Several thin wires that connect the device to your vagus nerve will be inserted.

Devices

The pulse-generating device is often a flat, round piece of metal containing a small battery, which can last for up to 15 years.

Standard models typically have a few adjustable settings. They usually providing nerve stimulation for 30 seconds every 5 minutes.

People are also given a handheld magnet, typically in the form of a bracelet. It can be swept across the device to provide extra stimulation if they feel a seizure coming on.

Newer VNS devices often contain autostimulation features that respond to your heart rate. They may allow for more customization as to how much stimulation is provided during the day. The latest models can also tell whether or not you’re lying flat after a seizure.

Activation

The VNS device is usually activated at a medical appointment several weeks after the implantation procedure. Your neurologist will program the settings based on your needs using a handheld computer and a programming wand.

Typically the amount of stimulation you receive will be set at a low level at first. Then it will be gradually increased based on how your body responds.

Who it’s for

VNS is generally used for people who have not been able to control their seizures after trying two or more different epilepsy medications and are not able to have epilepsy surgery. VNS is not effective for treating seizures that aren’t caused by epilepsy.

If you’re currently receiving other forms of brain stimulation, have a heart abnormality or lung disorder, or have ulcers, fainting spells, or sleep apnea, you may not qualify for VNS therapy.

Risks and side effects

Although the risk of experiencing complications from VNS surgery is rare, you may experience some pain and scarring at your incision site. It’s also possible you could experience vocal cord paralysis. This is temporary in most cases but can sometimes become permanent.

Typical side effects of VNS after surgery can include:

  • trouble swallowing
  • throat pain
  • headache
  • cough
  • breathing problems
  • tingling skin
  • nausea
  • insomnia
  • hoarse voice

These side effects are usually manageable, and may lessen over time or with adjustments to your device.

If you’re using VNS therapy and need to have an MRI, make sure to inform the technicians performing the scan about your device.

In certain cases, the magnetic fields from the MRI can cause the leads in your device to overheat and burn your skin.

Checkups following surgery

After VNS surgery, it’s important that you sit down with your medical team and discuss how often you’ll need to schedule visits to monitor your device’s functionality. It’s a good idea to bring a close friend or family member along to your VNS checkups for support.

Long-term outlook

Although VNS therapy won’t cure epilepsy, it may lower the number of seizures you have by up to 50 percent. It can also help shorten the time it takes you to recover from a seizure, and may help to treat depression and improve your general sense of well-being.

VNS doesn’t work for everyone, and isn’t meant to replace treatments like medication and surgery. If you don’t see a marked improvement in the frequency and severity of your seizures after two years, you and your doctor should discuss the possibility of turning the device off or having it removed.

The takeaway

If you’ve been searching for a non-drug option to complement your current epilepsy medications, VNS may be right for you. Talk to your doctor about whether you qualify for the procedure, and whether VNS therapy is covered under your health insurance plan.