Vagus Nerve Stimulation - Epilepsy Surgery

Vagus Nerve Stimulation - Epilepsy Surgery

Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) is an adjunctive treatment for certain types of intractable epilepsy and major depression. VNS uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin.

VNS implantation devices consist of a titanium-encased generator about the size of a pocket watch with a lithium battery to fuel the generator, a lead wire system with electrodes, and an anchor tether to secure leads to the vagus nerve. The battery life for the pulse generator is "between 1 [and] 16 years, depending on the settings [ie how strong the signal being sent is, the length of time the device stimulates the nerve each time, and how frequently the device stimulates the nerve.

Vagus nerve stimulation (VNS) is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. These pulses are supplied by a device something like a pacemaker.

The VNS device is sometimes referred to as a "pacemaker for the brain." It is placed under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck.

The vagus nerve is part of the autonomic nervous system, which controls functions of the body that are not under voluntary control, such as the heart rate. The vagus nerve passes through the neck as it travels between the chest and abdomen and the lower part of the brain.

Procedure

The procedure is performed under general anesthesia. A neurosurgeon implants the device, a generator about the size of a small tape measure, in the upper left area of the chest. A connecting wire is run under the skin from the device to the vagus nerve in the left side of the neck. Three small leads are then carefully attached to the nerve. Implantation is usually accomplished within 1 to 2 hours.

For a few days following the procedure, the generator is programmed to stimulate the vagus nerve at regular intervals (e.g., for 30 seconds every 5 minutes) at a frequency determined by the doctor and patient. The physician adjusts the frequency using a computer. If a seizure begins between intervals, the patient activates the stimulater by swiping a magnet over their chest at the location where the device is implanted.

Risks include possible surgical injury to the vagus nerve, carotid artery, and internal jugular vein.

Results

Many patients experience 50% reduction in seizure frequency, and seizures are less severe. Vagus nerve stimulation eliminates seizures in approximately 15% of patients, according to some studies, and a small number experience no improvement.

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