By: Dr. Sharon Elza Raju, BDS, MHA, LSSGB, PMEC and Natalie L. Boehm, MBA, RBLP-T
What is a VNS?
According to Mayo Clinic, a vagus nerve stimulation or VNS, involves using a device to stimulate the vagus nerve, to help treat epilepsy and depression. VNS therapy has been FDA approved in the United States for children over the ages of four with focal epilepsy as well as adults.
How does a VNS work?
When the VNS is implanted, the wire is connected to the left vagus nerve, which sends signals to the brainstem. According to LivaNova, the goal of the VNS is to reduce seizures, improve memory, help to decrease medication, improve alertness, mood, and memory, decrease status epileptics, decrease hospital visits, and improve the patient’s quality of life.
Who qualifies to receive a VNS?
A patient is considered for a VNS when two or more anticonvulsant medications fail to control seizure activity. A VNS can help to reduce seizure activity and improve recovery. Around thirty percent of people who have epilepsy are known to have drug-resistant or refractory epilepsy.
VNS Surgery and Recovery
VNS surgery is an outpatient procedure, where the implant is placed surgically. The patient is placed under anesthesia. Two incisions are made, one under the armpit or chest, while the other one near the neck. The pulse generator is then implanted on the upper side of the chest.
According to Mayo Clinic, a physical examination along with lab work is conducted to see if the patient qualifies for a VNS. Once the device is implanted, the pause generator can be activated by the doctor and programmed to deliver the impulses to the vagus nerve. The doctor can set the device to send impulses at the amount needed to help control seizure activity.
Symptoms from having a VNS
According to the article, Vagus nerve stimulation, side effects, and long-term safety, side effects are usually related to the “on” phase of stimulation. Cough, hoarseness, voice alteration, and paresthesias, which dimmish over time. No side effects such as cognitive impairment have been reported. According to the American Association of Neurological Surgeons, additional side effects can be general pain, throat or neck pain, throat or larynx spasms, headache, insomnia, indigestion, muscle movements or twitching related to the stimulation, nausea and/or vomiting, impaired sense of touch, and prickling or tingling of the skin.
Contact your physician right away if you experience the following:
- Constantly hoarse voice
- Stimulation which becomes painful or irregular
- Stimulation which causes choking, breathing, or swallowing difficulties or a change in heart rate
- Changes in your level of consciousness, such as increased drowsiness
- Signs that the pulse generator may not be stimulating properly or that the battery is depleted (device stops working)
- Any new or unusual changes related specifically to the stimulation
(AANS.org, 2021)
Maintenance of a VNS
According to LivaNova, the battery life can last 4.9-10 years, depending on the setting your doctor has it on. Your doctor will be able to tell when the battery needs replacing and can schedule a new generator to be placed. The procedure is an outpatient procedure that takes less than an hour (Epilepsy Action, 2019).
Conclusion
According to Mayo Clinic, a vagus nerve stimulation or VNS, involves using a device to stimulate the vagus nerve, to help treat epilepsy and depression. VNS therapy has been FDA approved in the United States for children over the ages of four with focal epilepsy as well as adults.
A patient is considered for a VNS when two or more anticonvulsant medications fail to control seizure activity. A VNS can help to reduce seizure activity and improve recovery. Around thirty percent of people who have epilepsy are known to have drug-resistant or refractory epilepsy.
VNS surgery is an outpatient procedure. There are common side effects when having the VNS turned on. If you are experiencing any of the negative side effects that were listed, it is important to contact your physician as soon as possible.
Resources:
American Association of Neurological Surgeons (2021). Vagus Nerve Stimulation. American Association of Neurological Surgeons. Retrieved from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vagus-Nerve-Stimulation
Ben-Menachem, E. (2001). Vagus nerve stimulation, side effects, and long-term safety. Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society, 18(5), 415-418. https://doi.org/10.1097/00004691-200109000-00005
Bhargava, H.D. (2020). Vagus Nerve Stimulation. WebMD. Retrieved from: https://www.webmd.com/epilepsy/guide/vagus-nerve-stimulation-vns
Epilepsy Action (2019). Vagus nerve stimulator (VNS) and epilepsy. Epilepsy Action. Retrieved from: https://www.epilepsy.org.uk/info/treatment/vns-vagus-nerve-stimulation
LivaNova (2018). An Introduction to VNS Therapy. VNS Therapy. Retrieved from: https://vnstherapy.com/sites/vnstherapy.com/files/Introduction-to-VNS-Therapy-English.pdf
LivaNova (2020). Health innovation that transforms lives, VNS picture. LivaNova. Retrieved from: https://www.livanova.com/en-us/home/therapeutic-areas.aspx
LivaNova (2018). The VNS Therapy® Magnet. VNS Therapy. Retrieved from: https://vnstherapy.com/sites/vnstherapy.com/files/VNS-Therapy-Magnet.pdf
Mayo Clinic (2020). Vagus Nerve Stimulation. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565
Shafer, P.O. and Dean, P.M. (2018). Placement, Programming, and Safety of Vagus Nerve Stimulation (VNS). Epilepsy Foundation. Retrieved from: https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation/placement-programming-and-safety-vagus-nerve-stimulation-vns
Shafer, P.O. and Dean, P.M. (2018). Vagus Nerve Stimulation (VNS). Epilepsy Foundation. Retrieved from: https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns
