Epilepsy

Vagus nerve stimulation (VNS)

Anti-epileptic drugs control seizures in most people with epilepsy. But for those people for whom drugs do not work there are other forms of treatment such as surgery. Another form of treatment is Vagus Nerve Stimulation (VNS). The vagus nerve is one of the many nerves which carry messages to and from the brain and is found on the left side of your neck.

The operation involves implanting a small electrical device, similar to a pacemaker, under the skin, near the collarbone. The device has a wire that is wrapped around the vagus nerve. The device passes a regular dose of electricity to the nerve to stimulate it. The battery for the VNS device typically lasts up to 10 years, after which time a further procedure will be needed to replace it.

VNS can reduce the frequency and intensity of seizures in some people but very few become totally seizure free, and most people continue to take anti-epileptic medication. How and why VNS works is not fully understood, but it is thought that stimulating the vagus nerve alters the chemical transmissions in the brain.

If a consultant believes that VNS might be an option there are a number of criteria a person has to meet, before they can be considered for treatment with a VNS.

For Focal-Onset Seizures:

  •    the person has seizures that occur in spite of the correct levels of anti-epileptic drugs or 
  •    seizures cannot be treated with anti-epileptic drugs because of intolerable side effects.

And

  •     the patient has failed or is not eligible for surgery.

And

  •     at least 2 complex partial seizures per month OR recurrent life threatening status epilepticus
  •     3 first line anti-epileptic drugs have been tried over a period of at least 2 years.

For Generalised Seizures:

  •     the person has seizures that occur in spite of the correct levels of anti-epileptic drugs or 
  •     seizures cannot be treated with anti-epileptic drugs because of intolerable side effects.

And

  •     the patient has failed or is not eligible for surgery. 

And

  •     at least 1 generalised seizure per month OR recurrent life threatening status  epilepticus
  •     3 first line anti-epileptic drugs have been tried over a period of at least 2 years.

The full effects of VNS may take up to 18 months to develop. 

Most people experience mild side effects when the system is first installed and when the vagus nerve is actually being stimulated. One woman, who had a VNS implanted in 2001, recalled how she felt after the operation.

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Reported side effects include pain or discomfort in the face or neck, a tickly throat and/or cough, headache and alteration of the voice. As the person gets used to the device, the side effects may lessen. Adjusting the intensity, frequency or duration of the stimulation may also help. The person can use the hand-held magnet to deactivate the generator or to increase the stimulation. This woman explained how she got used to having the VNS despite a few side effects. A carer, who told us about her 15-year-old daughter, reported problems with the magnet.

One woman discussed how VNS improved her seizures and quality of life. But VNS does not work for everyone and, if there is no improvement after 18-24 months, the person may choose to have the generator removed. This woman explained that VNS had not worked for her daughter. Her daughter had since had neurosurgery and the VNS would soon be removed. Another woman explained why she decided against having VNS but thought that the technique would improve with time.

Last reviewed May 2016.
Last updated May 2016.

 

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