Vagus Nerve Stimulation, epilepsy treatment, VNS surgery, Phoenix, Arizona
The epilepsy team includes some of the most respected pediatric epilepsy specialists in the country. The Comprehensive Pediatric Epilepsy Program is a key component of the Barrow Neurological Institute at Phoenix Children’s Hospital, a premier program dedicated to the evaluation and treatment of neurological disorders in children and adolescents. Kids from across the country visit us for our world-class program, which includes an epilepsy treatment option – vagus nerve stimulation.
The vagus nerve connects the brain to a variety of organs in the chest and abdomen. Vagus nerve stimulation, or VNS, is an epilepsy treatment that sends electrical signals through the vagus nerve to the brain. This therapy has been proven effective in treating partial epilepsy, although the exact way it works is unknown.
VNS is for patients age 12 or older who have partial seizures and meet all of the following criteria:
- The child has intractable epilepsy – epilepsy that cannot be adequately controlled through medication
- The child has no option for brain surgery (e.g., the epilepsy is coming from a part of the brain that cannot be removed safely)
- The child has no underlying condition that could make VNS surgery unsafe, such as certain surgeries previously performed in the left side of the neck
A small electrical generator, about the size of a silver dollar, is implanted in the chest. Thin wires are then attached to the battery and coiled around the vagus nerve. At regular intervals, the device sends mild electrical pulses to the vagus nerve.
A neurologist programs the strength and timing of the pulses, depending on the condition and needs of each child. The neurologist uses a programming wand connected to a laptop computer, without entering the body.
The VNS works by automatically stimulating the brain based on the programming provided by the neurologist. In addition, if the child feels a seizure starting, he or she can hold a special magnet near the device, which triggers the electrical pulse manually. This may help to stop the seizure or reduce its intensity.
During VNS surgery
The surgery is an outpatient procedure that is done under general anesthesia. The surgeon makes two incisions, one in the armpit and one in the left side of the neck. Through the opening in the armpit, the surgeon places the generator just underneath the skin in the chest. Through the neck incision, electrodes are gently wound around the vagus nerve, then threaded down to the generator, where they are connected.
The surgery generally takes 60 to 90 minutes, and the child stays in the hospital overnight. Afteward, most children are able to go home.
After VNS surgery
In 10 days, your child will go back to the neurosurgeon to have the dressings removed. The stimulator usually will be turned on approximately two weeks after surgery, although it may be turned on during surgery as well. It's important for your child to keep taking any anti-seizure precautions recommended by the neurologist, since VNS will probably not stop the seizures entirely.
The VNS device is programmed to come on every few minutes, 24 hours per day. The neurologist will make adjustments to the program every one to three months based on your child's seizure activity. During each office visit, the neurologist will also make sure the device is working properly.
Initially, your child will need to return every two to four weeks, then every three to six months depending on how he or she is doing.
The effects of VNS are highly dependent on each patient. In general, of every 100 patients:
- 1/3 will have major improvement in seizure control
- 1/3 will have some improvement
- 1/3 will not have improvement
- Very few are seizure free
The number of medications can sometimes be decreased, depending on how your child is doing.
It's critical for the child to remain under the care of his or her neurologist, keeping regular appointments and following care instructions as recommended.
Side effects may include:
- Shortness of breath
- Pain or discomfort in the throat
- A change in the voice
- Swallowing difficulties/breathing in mucus or saliva
- Infection (in rare cases)
VNS is not affected by:
- Airport security devices
- Cell phones
There are certain things to be aware of:
- An MRI (magnetic resonance imaging scan) of the head requires a special head coil, and VNS must be turned off during the procedure.
- An MRI of spine cannot be done.
Strong magnets or hair clippers may cause accidental magnet activations. It's best to keep such objects at least 6 inches away from the location of the VNS device.