Magazine article The Exceptional Parent

Vagus Nerve Stimulator: Another Option for Treatment of Epilepsy

Magazine article The Exceptional Parent

Vagus Nerve Stimulator: Another Option for Treatment of Epilepsy

Article excerpt

EPILEPSY

Epilepsy is a common neurological disorder, affecting about 2.7 million persons in the United States. Epilepsy is defined as two or more seizures occurring without a clear cause (such as infection, dehydration, acute injury, fever or sleep deprivation.)

The goal of epilepsy treatment is to suppress the abnormal electrical activity in the brain enough to prevent seizures while avoiding side effects of medication. Better seizure control has been shown to improve cognitive outcomes and improve quality of life in patients and their families.

INTRACTABLE EPILEPSY

Epilepsy can often be difficult to control. About 900,000 persons with epilepsy in the United States are deemed to have intractable or refractory seizures. Refractory or intractable epilepsy is defined as seizures that cannot be controlled with medications alone. It is diagnosed when a patient fails two appropriately chosen, correctly dosed and tolerated AEDs (used alone or in combination) for a sufficient period of time.

Patients with intractable epilepsy should be referred to a Comprehensive Epilepsy Center for treatment by a team that is familiar with all treatment options, including surgery, diet and medications.

SURGERY FOR TREATMENT OF EPILEPSY

When two or more anti-epileptic medications fail to control seizures, the patient is considered a candidate for epilepsy surgery. Options for epilepsy surgery include resective surgery, corpus callosotomy, multiple subpial transections and the vagus nerve stimulator (VNS Therapy[R]).

Epilepsy surgery is notoriously underutilized in the United States, and all over the world. In the United States, only about 3,000 epilepsy surgeries are performed annually and only about an additional 3,500 vagus nerve stimulators are placed each year. This leaves a substantial number of refractory patients who do not receive adequate treatment. In part, this is related to lack of adequate information regarding treatment options.

Parents, families and caregivers, as well as persons with epilepsy, frequently have questions about treatment options and may have difficulty obtaining accurate information. Some of these inaccuracies can result in patients and families erroneously discounting treatment options that may be beneficial.

One of these treatments is a neurostimulation device--the vagus nerve stimulator. This involves minimally invasive and reversible surgery.

THE VAGUS NERVE STIMULATOR

The vagus nerve stimulator improves seizure control by reducing the frequency and severity of seizures. It has been shown in clinical trials to reduce seizures by about half in 30% of the patients in the trials. It was FDA approved for refractory epilepsy in 1997 and for depression in 2005. The VNS Therapy System is indicated for use in the United States as adjunctive therapy to reduce the frequency of seizures in adults and adolescents over 12 years of age with partial onset seizures that are refractory to antiepileptic medications. It is also used in children and in patients with generalized seizures.

The VNS Therapy System consists of an implanted pacemaker-like generator attached to a stimulation lead, which delivers mild intermittent stimulation to the patient's left vagus nerve which sends signals to the brain.

The procedure consists of implanting the generator under the skin (usually in the left chest) and threading the lead up through the neck to the vagus nerve, where electrodes are gently placed on the nerve. The pacemaker is about 5 mm thick. This requires a one day or overnight stay in the hospital, in most cases, and is performed under general anesthesia. Two incisions are made, which are usually barely visible after healing. The patient is discharged with dressings in place (which are either removed by the neurosurgery team at a post-operative visit.) Initial stimulation ("turning on" the device) may be performed in the operating room, during the hospital stay, or at the neurology appointment after discharge. …

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