Vagus Nerve Stimulation for Epilepsy

Abstract

Epilepsy refractory to medical management with antiepileptic drugs continues to pose a problem to clinicians as well as to patients struggling with the limitations imposed on them by their condition. Vagus nerve stimulation (VNS) is a safe and effective surgical treatment for patients with refractory epilepsy who are not candidates for surgery involving resection of temporal lobe structures or epileptogenic foci. Even in those with failed surgical resection, VNS may still provide some benefit, though this must be elucidated. Although the mechanism is still poorly understood, several theories exist as to how VNS exerts its antiepileptic effects and several clinical trials have demonstrated its efficacy and safety. VNS has become the most widely used nonpharmacological therapy for the treatment of drug‐resistant epilepsy.

Key Concepts:

  • VNS is a safe and effective treatment for patients with refractory epilepsy who are not candidates for surgery involving resection of temporal lobe structures or epileptogenic foci and possibly those that have failed to respond to surgical correction.

  • Increased reduction of seizure frequency with VNS occurs over time resulting in decreased need for antiepileptic drugs with increased duration of stimulation.

  • In addition to the benefit of seizure reduction, data exists to support improved subjective quality of life scores with use of VNS.

  • Although the insertion of the VNS unit is a surgical procedure, it can often be performed as an outpatient surgery and thus does not require inpatient hospitalization as resection‐based epilepsy surgery does.

  • VNS is generally well tolerated with side effects including mild and including voice alteration and throat pain.

Keywords: vagus nerve stimulation; refractory epilepsy; epilepsy surgery; epilepsy

Figure 1.

Comparison of the newer implant model (103) compared to prior models. Average battery life is 6 years. Used with permission from Cyberonics, Inc. © 2006 Cyberonics, Inc. All rights reserved.

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Further Reading

Rielo D and Benbadis SR (2007) Vagus nerve stimulation. eMedicine Journal [serial online]. http://www.emedicine.com/neuro/TOPIC559.HTM.

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Haas, Alexander M, Benbadis, Selim R, and Vale, Fernando(Oct 2014) Vagus Nerve Stimulation for Epilepsy. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0020285.pub2]