Neurostimulation Surgeries

You may not be a candidate for resective surgery because:

The area where the seizures start cannot be clearly identified or localized with the tests performed.
A previous surgery did not work as expected.
The area where the seizures start is responsible for very important brain functions like memory, speech, etc.
It is contraindicated due to other medical conditions.

Other treatment options are available for people with drug-resistant epilepsy who meet the criteria mentioned above.

With the advances in technology, medical devices have been developed and approved as safe and effective alternatives for those who are not candidates for resective surgeries.

Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) is a procedure in which electrodes (leads) are implanted deep into the brain to stimulate different areas to control seizures. DBS has been considered another safe and effective procedure and has been used for the treatment of multiple diseases in the nervous system like Parkinson’s disease.

Responsive Neurostimulation (RNS)

Responsive Neurostimulation (RNS), also known as brain-responsive neurostimulation consists of a system that includes a programmable generator (stimulator), flexible wires (leads) and an external device called programmer. The goal of RNS is to reduce the frequency and severity of the seizures by sending electrical stimulation to reduce abnormal activity in the brain.

Vagus Nerve Stimulation (VNS)

Vagus Nerve Stimulation (VNS) works with a small generator that sends electrical signals to the brain through the vagus nerve disrupting abnormal brain activity that causes seizures. The goal of VNS is to reduce the number and severity of the seizures.

The vagus nerve is the longest and more complex of the 12 cranial nerves that originates in the brain and connects with organs and tissues in the neck, chest and abdomen. The vagus nerve controls involuntary body functions such as breathing, heart beating, digestion and many others.

A person with drug-resistant epilepsy who has no other remaining surgical option, is a candidate for VNS.

During surgery, the surgeon will make two small cuts. The first one is to implant the battery-operated generator (similar to a pacemaker) on the upper left side of the chest below the clavicle. A second cut is made on the left side of the neck to introduce a thin, flexible wire (lead) that connects the generator to the left vagus nerve. The right vagus nerve has more activity on the heart slowing the beating. For this reason, the left vagus nerve is the one used to be implanted with the lead by winding the wire around the nerve.

Once the generator and the wire are implanted, the system is tested. Usually, neurologists prefer to wait one or two weeks before initiating stimulation therapy, but in some cases, it may be activated in the operating room at the time of implantation.

When the system is in place and tested, the cuts are closed with stitches.

The treating doctor will see you again to program the stimulator. The amount of stimulation varies, but is usually initiated at a low level and then increased slowly to a desirable level. Each case is evaluated individually and the programming is adjusted accordingly. The programming is done by using a small computer and an external programming wand.

To make sure the stimulator and the system are working properly, you need to see your specialist regularly. The stimulator battery lasts years and it is replaced when the battery runs low.

You will receive a special magnet that works like a remote control. This magnet can help you to stop an irregular seizure that starts at a different time from the regular nerve stimulation.

Although VNS is a safe minimally invasive procedure, there is a risk of complications including bleeding and infections. Side effects such as a raspy and rough voice, cough, muscle tightness, discomfort on the chest where the stimulator was implanted and feeling of being close to passing out have been related to the procedure and they usually improve over time. Discuss with your surgeon and healthcare professionals in the team about the benefits and risks of this procedure.

For more information and frequently asked questions about vagus nerve, read this printable resource.

Ask your doctors if you might be a candidate for any of the neurostimulation surgeries and learn about the potential benefits and risks for you.