Vagus nerve stimulation therapy (VNS)
Vagus nerve stimulation (VNS) is a treatment for epilepsy where a small generator is implanted under the skin below the left collar bone. This is connected to a lead with three coils at one end. These coils are wrapped around the vagus nerve in the left side of the neck in a small operation. The VNS stimulates the vagus nerve at intervals to reduce the frequency and intensity of seizures.
How does it work?
The generator sends impulses from the vagus nerve in the neck to the brain and delivers therapy in two ways:
1. A doctor programmes a 24-hour a day, seven-day a week "dose" of intermittent stimulation. One such dose frequently used is 30 seconds of stimulation followed by a five-minute period of no stimulation. The stimulation is automatically delivered.
2. When a patient, a family member or a caregiver senses a seizure coming on, they can pass a magnet over the area in the chest where the generator is implanted. This activates an extra, on-demand stimulation.
What does the operation involve?
The generator and lead are implanted into the chest and left neck area, in a procedure that involves:
- an operation, which lasts approximately one to two hours
- an incision on the left side of the neck for the lead
- an incision on the left upper chest or armpit for the generator
- a stay in hospital of around one or two days
Two small scars will be evident after surgery. The scar in the left upper chest area is for the generator and the one in the skin creases in the neck is for the lead. These are usually not noticeable or fade with time. There may also be a small bulge on the left upper chest where the generator is positioned.
How is the generator programmed?
During routine outpatient visits, the doctor can read and adjust stimulation settings using the programming computer and the programming wand. This is painless and can be done through the clothes. The doctor places the programming wand over the area where the generator is and programmes this with the computer.
Who would benefit from this procedure?
Vagus nerve stimulation is suitable for people with any type of epilepsy that has proven difficult to control.
Around 43,000 people worldwide have been implanted with vagus nerve stimulators. These people are of all ages, with a variety of seizure types and epilepsy syndromes.
What are the risks?
As the operation is carried out under general anaesthetic, it carries a slight risk of reaction to the anaesthetic. There is also a small risk of bleeding or infection. There may be some pain from the site of the operation. This can be relieved with mild painkillers.
The doctor who carries out the operation will talk to the person in more detail about the risks involved, before the operation takes place.
What are the side effects?
Certain side effects are associated with VNS. The most commonly reported side effects are:
- temporary hoarseness/change in voice tone
- sore/tickling throat
- shortness of breath
- coughing
These problems usually happen during the ‘on’ time, which is usually about 30 seconds every five minutes. Most people who experience hoarseness tolerate it well and notice it less as time goes on.
Other discomforts such as breathing difficulties can happen if the generator setting is too high initially or is increased too rapidly. If this happens, the doctor can re-programme the stimulation settings.
Will the VNS stop the seizures?
Studies show that most people with a VNS have a reduction in seizure frequency, although some have no change. It can take from a couple of months to two years to see a noticeable reduction.
Due to experiencing fewer and less severe seizures, some people have reported a better quality of life.
Will anti-epileptic medication be discontinued?
Medication will continue as normal while receiving stimulation, for at least the first three months after implantation. After three months, the doctor will review the person’s medication and advise them if they need to make any changes.
Will the generator need to be replaced?
Yes, but only after some years. The latest generators need to be replaced around every six to eleven years. The higher the frequency and output of the stimulation, the faster the battery will run down. A doctor or nurse can tell when the battery is running down by reading the VNS therapy device. They will then arrange for a new generator to be implanted. This involves a small operation, which takes less than an hour and does not usually require an overnight stay.
Is VNS available to NHS patients?
It is available to both NHS and private patients.
Details of implant centres and programming can be obtained on the Vagus Nerve Therapy website, or from your GP and specialist.
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Website www.fable.org.uk
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Comments
I have had my VNS for 8 years it has done a little bit of good for me, it may do good for some. I am still on the same amount of med. as before I got the VNS.
This thing does not help me that much I am looking for another answer please help. All of my brain is involved in a seziere, and I have all types.
i had my VNS implanted 2 years ago as at 20 years of age i was trying to study and my siezures were very frequent. At 22 I am now almost 12 months free of siezures and am due to qualify in my studies in september. the VNS has defenitely helped me, i have had a few problems with the adjustments of the intensity but to know that i now have control over my siezures is rewarding and i can finally consontrate on other aspects of my life.
congratulations in ur qualifications... I don't know how you've gone on, but i was always being put down off my consultant when i told him what i was studying; i am training to be a teacher, i am a lifeguard and swimming instructor, first aider, cub scout leader plus more. i was always told off my consultant I would never make it to these qualifications - but i did :)
they are applying for the funding for my VNS at the mo I am preying that they get it it's getting where my seizures are effecting me more that even and the side effects of tablets are just horendous - they tried every tablet for epilepsy up to now. i hope it makes the same difference to my life as it does to yours
Hello. My name is Jo and I have a son with a chromosome abnormality called ring 20. He had the VNS device put in in september 07. Today we had another appointment up at Kings College and he is now on the rapid cycle, 30 seconds off - 7 seconds on. Up till now the device has not made any difference to my sons seizures. My husband and I are hoping that the cycle that our son is now on will help, but I'm not to sure, fingers crossed it will work, or cut them right down. Our son has several seizures a day, (some lasting about 30 - 40 mins, which is normal in ring 20) We will keep you posted.
I have epilepsy and have many different types of it, so I am on tonnes of medication. I have been offered VNS surgery recently and have been told to think about it. I have heard the medical pros, but as yet no cons. I would really like to know how a normal person, who wears the device on a daily basis, feels about it! How have you coped? Has it helped for better, for worse? Do you feel self-conscious about it being noticable? If anyone can let me know, I'm sure I'm not the only one who has these worries. Thanks.