What is Vagus Nerve Stimulation Surgery?

Vagus Nerve Stimulation (VNS) are used to treat drug resistant epilepsy and major depression disorder. Vagus Nerve Stimulation surgery (sometimes referred to as a "epilepsy battery") is a technological surgical

procedure involving, the placement of an electrode over the vagus nerve which located in the left neck area, and connecting this electrode to a implantable pulse generator.

This implantable pulse generator sends electrical impulses to the vagus nerve through implanted electrodes, this nerve transfers these impulses to the special brain area to control abnormal signals which responsible for seizures.

How is Vagus Nerve Stimulation surgery performed?

Placing the Vagus Nerve Stimulation electrode and the battery is not a difficult procedure. The surgery is mostly done under general anesthesia.

Firstly, the electrode must be implanted over the left Vagus nerve which located in the cervical (neck) area. After the implantation the electrode it must be tunneled under the skin and connected to the implantable pulse generator which implanted under clavicle.

The best advantages such these operations are reversibility and adjustability (all Neuro modulation approaches like Intrathecal Baclofen Pump, Spinal Cord Stimulation, Deep Brain Stimulation, Sacral Nerve Stimulation, and Vagal Stimulation and are reversible interventions, therefore they never result with permanent damage).

Who's Candidate to Vagus Nerve Stimulation Surgery?

Vagus nerve stimulation is intended for patients who have failed or cannot tolerate more conservative treatments for epilepsy or major depression.

The goal of VNS is to reduce the number, length and severity of seizures. VNS may also reduce the time it takes to recover after a seizure. However, VNS is not successful in all patients. The success of this treatment differs - some patients report less frequent seizures, others report a slight reduction, while some patients do not respond at all.

The following results have been noted in select patients with epilepsy:

* Less severe or shorter seizures

* Better recovery after seizures (postictal period)

* Improved sense of well-being

* Improved mood

* Improved alertness, memory and cognitive skills

* Fewer emergency room visits

Which important factors are important to decide to do Vagus Nerve Stimulation Surgery?

The most important factors about the decision is if the patient failed or cannot tolerate more conservative treatments like medications.

The Food and Drug Administration (FDA) has approved vagus nerve stimulation for people who:

* Have focal (partial) epilepsy

* Have seizures that aren't well-controlled with medications

* Have chronic, hard-to-treat depression (treatment-resistant depression)

* Haven't improved after trying four or more medications or electroconvulsive therapy (ECT), or both

What are the advantages of Vagus Nerve Stimulation (VNS) surgery?

Proven as more effective and safer than ablative approaches Long-term complications are fewer than with traditional surgery because traditional surgery involves destroying small parts of the brain, while VNS does not.

Reversible: The system doesn't result with permanent damage. The stimulation can be turned off by remote control.

Adjustable: The stimulation settings can be adjust by a remote control.

Rechargeable: There is a rechargable Implantable pulse generator option.

Can be activated when required: Patients are provided with a handheld magnet (Magnet

Bracelet, Figure 4) to control the stimulator at home (which must be activated by the physician to magnet mode). When the magnet is swept over the pulse generator site, extra

stimulation is delivered regardless of the treatment schedule. Holding the magnet over the pulse generator will turn the stimulation off while the magnet is in position. Removing it

will resume the stimulation cycle. All maneuvers performed with the magnet can be done by the patient, family members, friends or caregivers.

What are the risks for Vagus Nerve Stimulati Surgery?

You need to remember there isn't any surgery without risk.

General complications of any surgeries are bleeding, infection, blood clots, and reactions to anesthesia. But the experience of the whole surgery team is so important like all surgeries. Side effects are most commonly related to

stimulation and usually improve over time. These may include any of the following: Hoarseness, Increased coughing, Changes in voice/speech, General pain, Throat or neck pain, Throat or larynx spasms, Headache

Vagus Nerve Stimulation surgery may also cause to pain at the electrode or stimulator site, allergic response to implant materials. In that point the evaluation of the patient before the surgery by an experienced team is crucial. 

Our team has experience more than 200 surgeries and include Neurosurgeon, Neurologist, Programmer Physician, Physical

Therapy and Rehabilitation physician and technicians and neuropsychiatrist.

Treatment-Resistant Depression

Soon after VNS was approved by the FDA as a seizure treatment, reports indicated a possible decrease in depression symptoms in patients who had the device implanted for seizure control. Like electroconvulsive therapy, VNS is

believed to work by using electricity to influence the production of brain chemicals called neurotransmitters. Depression has been tied to an imbalance in those chemicals.

In studies involving more than 200 patients leading to the 2005 FDA approval of VS for treatment-resistant depression (TRD), the device showed no benefit during the first two or three months. After one year however, 20-30 percent of patients reported significant improvements, and half of these patients reported that their symptoms had nearly

resolved completely. However, other patients did not improve or their symptoms worsened. VNS has been FDA-approved for people with chronic or recurrent TRD who have failed to respond to four or more adequate treatments.

Individuals with any of the following criteria may potentially be unsuitable candidates for VNS:

• One vagus nerve: If the patient has only one vagus nerve

• Heart arrhythmias or other heart abnormalities

• Lung diseases or disorders (shortness of breath, asthma, etc.)

• Ulcers (gastric, duodenal, etc.)

• Vasovagal syncope (fainting)

• Pre-existing hoarseness

BY RECMED MEDICAL - BRAIN AND NERVE SURGERY DOCTORS