Treating Epilepsy with VagusNerve Stimulation

Posted: September 2, 2020 | Revised: October 6, 2020

If you or someone you know has drug-resistant focal epilepsy — recurring seizures that impact one half of the brain and cannot be treated successfully with seizure medications — it may be time to try Vagus Nerve Stimulation (VNS). An FDA-approved treatment, VNS involves a small incision on the chest and neck to implant a device that provides electrical stimulation to the vagal nerve (a battery-powered pulse generator is implanted in the upper left of the chest and connected to a lead wire before being connected to the left vagus nerve). This cranial nerve carries signals between the brain and the rest of the body, so as it is stimulated, the frequency of seizures can significantly decrease over time. We’re talking 28% in the first three months, 36% at six months, 58% in four years and potentially 75% over a decade.

How Does It Work?

Think of it this way — many people experience an increased heart rate before a seizure. With VNS, the aforementioned device stimulates the vagus, thereby lowering the heart rate and increasing the transmission of antiepileptic neurotransmitters. Regular bursts of stimulation — with starts and stops for certain periods of time over 24 hours — are programmed into the device to decrease the frequency and severity of seizures.

A specialist programs the strength and timing of the stimulation, according to each patient’s needs. The specialist can then adjust the settings (output current, signal frequency and pulse width) by placing a wand over the generator on the left side of the chest. The wand either connects to a handheld computer, or it is wireless — meaning it is used with a model that can automatically adjust the settings every two weeks, up to seven times before the patient must return to the doctor. As the settings are adjusted, patients come to tolerate the stimulation more, and the device’s functionality can improve. (Epilepsy.com)

Patients can manually trigger an extra burst of stimulation with a magnet kit when they feel a seizure coming on. They swipe the magnet to stop the seizure or control its severity or how long it lasts.

Who is a VNS Candidate?

While VNS is not a cure for epilepsy, many patients are able to decrease the dosage of their medication postsurgery. To qualify, you must:

  • Be a four-plus year old with focal epilepsy who has not had luck with epileptic surgery
  • Have tried at least two seizure medications
  • Have been evaluated by an epilepsy specialist

Side Effects of VNS

The risks of VNS surgery are minimal — wound infections and impact of a nerve to the vocal cords. Side effects of stimulation may include coughing, tightness or pain in the neck or throat area, headache, insomnia, hoarseness, worsening of sleep apnea and difficulty breathing — all of which disappear over time or can be altered via a change in the device settings or a pause in stimulation.

To lessen the chances of these side effects, your doctor will conduct a physical exam — which may be coupled with blood tests or antibiotics — before surgery. A few weeks after surgery, the pulse generator is turned off before being programmed to start at a low level and gradually increased (MayoClinic.org).

Additional Benefits of VNS

In addition to the antiepileptic benefits of VNS, it is also associated with improving:

  • Sexual function
  • Mood and general sense of well-being (external resources like WebMD.com, PsychiatricTimes.com and the National Center for Biotechnology Information back this up)
  • Anxiety

Vagal nerve stimulators are even undergoing an FDA trial for treatment-resistant depression. Further to that, VNS is approved in Europe as an adjunctive long-term treatment for chronic or recurrent depression in 18-plus-year-olds who are both unipolar and bipolar and have not responded well to at least four antidepressant treatments.

Wondering if VNS is right for you? Contact Vascular & Vein Center at Gulfcoast Surgeons today — (239) 939-1767.

Our highly experienced vascular specialists are happy to treat you and address any questions or concerns you may have.