Before You Consider VNS Therapy

Many people with epilepsy may hear of vagus nerve stimulation as a potential treatment. It is an option—but experts at University of Utah Health recommend a thorough evaluation for epilepsy surgery as the first step. There are many types of epilepsy surgery, some far more effective than VNS. Work with your doctors to find out which surgery is best for you.

Epilepsy Surgery

Epilepsy surgery is one of the most effective treatments in all of surgery, and yet the majority of people with epilepsy don’t know about the potential benefits. If you have epilepsy and have tried at least two medications without success, it is time to talk to a specialist about surgery for epilepsy. 

While most epilepsy surgeries are brain surgeries, they are modern and safe procedures that could dramatically improve your quality of life.

Seizures from epilepsy that are uncontrolled can possibly increase injuries to your body. They can even end with sudden unexpected death in epilepsy (SUDEP). Seizures can also make being independent harder—you might feel socially alone and emotionally drained.

Epilepsy surgery could turn things around in a big way.

Epilepsy Surgery Types

There are several types of epilepsy surgery. These include:

  • focal resection,
  • laser ablation,
  • temporal lobectomy,
  • corpus callosotomy, and
  • multiple subpial transections (MST).

These involve removing the part or parts of your brain that are causing your seizures, or disconnecting the epileptic regions. Sometimes the place where the seizure originates is in a spot that’s too dangerous to remove. These regions, which doctors call, “eloquent brain areas,” are responsible for controlling vital functions including speech, memory, vision, and motor control. In these cases, surgical options still exist, such as responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS).

Vagal Nerve Stimulation (VNS) & Epilepsy

VNS is approved by the FDA to treat epilepsy. This stimulation sends regular, mild pulses of electrical energy to a nerve in the neck which helps prevent or make seizures less severe.

What Is the Vagus Nerve?

Most people don’t know the vagus nerve by name. It runs from the base of your brain, through your neck and down each side of your body. (Vagus means “wandering” in Latin.)

The vagus nerve plays a role in several key functions, including:

  • heart rate,
  • breath, and
  • the ability to relax.

It’s even responsible for “gut feelings,” because it tells your brain how your body’s organs are doing at any given time. The mind-body connection is very real.

Vagus Nerve Disorders

Problems linked with vagus nerve can include:

Vagus Nerve Stimulator Surgery

You will first have a surgery to implant the vagus nerve stimulator. The surgery is an outpatient surgery, which means you can leave on the same day as your surgery. It’s also relatively quick.

Your doctor will use general anesthesia to make you comfortable. He or she will then make an incision in the left side of your neck to attach a spiral-shaped electrode around the nerve (which looks like a piece of linguine). Then your doctor will make a second incision in your chest to implant a pacemaker called a pulse generator or vagus nerve stimulator. There are no incisions on your head.

Vagus Nerve Stimulation Device Programming

A few weeks after surgery, you’ll return to the hospital where your doctor will program the VNS device to deliver electric impulses in regular intervals (for example, 30 seconds on and off for five minutes). While the pulse generator won’t detect seizures, you can use a special magnet to manually start the device if you feel a seizure coming.

You can also use the magnet to turn off your VNS device, like when you’re speaking or singing in public—VNS therapy can make your voice hoarse. You might also have a slight pain in your neck when the currents are surging.

While VNS therapy is not a cure for movement disorders or other conditions, it can:

  • reduce the length and severity of seizures,
  • improve your mood,
  • improve your overall quality of life.

Next Steps

If you would like to find out more information about vagus nerve stimulation, you will need to get a referral. You do this by seeing your primary care doctor or neurologist and requesting a referral to a comprehensive epilepsy center (such as the University of Utah), to be evaluated for epilepsy surgery.