Vagus Nerve Stimulation
What is vagus nerve stimulation?
Vagus nerve stimulation (VNS) is new technology used to treat certain forms of seizure disorder and depression. It works by sending mild electrical pulses to the brain through the vagus nerve. The vagus nerve is the longest cranial nerve in the body. It contains both sensory and motor nerve fibers. It controls involuntary muscles and such body processes as heart rate, blood pressure, and food digestion.
VNS therapy is adjunctive, or add-on therapy to other treatments. A device similar to a pacemaker generates the pulses. Your doctor places the device under the skin of your chest. A wire connects the device to the vagus nerve in your neck. The pulses from the vagus nerve stimulator can reduce the number of seizures in some people. Doctors also use VNS to help people with treatment-resistant depression.
Placement of the VNS device and wire is a minimally invasive procedure with some level of risk and potential complications, as well as side effects from VNS itself. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having VNS.
Why is vagus nerve stimulation performed?
Your doctor may only consider VNS for you if other treatment options, such as antiseizure medicine, that involve less risk of complications have been ineffective.
Your doctor may recommend adding VNS to treat:
Lennox-Gastaut syndrome, a type of epilepsy
Chronic or recurrent depression in people 18 years and older
VNS can reduce the number, severity, and recovery time of seizures in most people with these forms of epilepsy. VNS can also improve mood and overall well-being, which is particularly important for people with treatment-resistant or recurrent depression. It appears that VNS affects the activity of certain nerve chemicals that play a role in mood disorders.
Keep in mind that vagus nerve stimulation does not work for everyone and does not replace more traditional treatments for these conditions. VNS is intended as one part of a comprehensive treatment plan you decide on with your doctor’s recommendations.
Who performs vagus nerve stimulation surgery?
The following specialists commonly perform surgery for VNS:
General surgeons surgically treat many diseases, disorders and conditions.
Otolaryngologists (pronounced “ōtō-lar-en-gäl-e-jest”), also known as ear, nose and throat (ENT) doctors, specialize in the medical and surgical care of the ears, nose and throat, and conditions affecting the head and neck.
Neurosurgeons surgically treat diseases and conditions of the brain and nervous system.
Your neurologist will manage the VNS device once a surgeon implants it. When searching for a surgeon to implant the device, one of the top concerns is the surgeon’s experience. Even if your neurologist recommends a surgeon, ask the surgeon how many VNS procedures he or she performs a year. You want a surgeon who performs the surgery on a regular basis with a very low rate of surgical complications.
How is vagus nerve stimulation surgery performed?
Your VNS will be performed in a hospital or surgery center. It is a minimally invasive procedure that can take up to 90 minutes. Your surgeon will make two incisions. The first one is in the upper chest area to implant the pulse generator. The other incision is in the lower left side of the neck. This is where the wire from the pulse generator will connect to the vagus nerve.
Types of anesthesia that may be used
Your doctor will perform VNS using a general anesthetic. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You will not feel anything.
What to expect the day of your VNS surgery
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer your questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing while you are under general anesthesia.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of vagus nerve stimulation surgery?
As with all surgeries, VNS has risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of VNS surgery
Most VNS procedures are successful, but potential complications include:
Neck or chest pain
Side effects of VNS therapy
Side effects of stimulating the vagus nerve include:
Coughing, choking, breathing difficulties, swallowing problems, and changes in heart rate
Voice changes including hoarseness
In most cases, adjusting the length of time or intensity of stimulation corrects these side effects. These adjustments are made without additional surgery.
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have allergies
How do I prepare for vagus nerve stimulation surgery?
The steps you take before surgery can improve your comfort and outcome. You can prepare for VNS by:
Answering all questions about your medical history, allergies, and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing VNS surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon or the specialist coordinating your care with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need VNS? Are there any other options for treating my condition?
What results do you usually see? Do you have outcomes data to share?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the surgery take? When can I go home?
What kind of restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after vagus nerve stimulation surgery?
Knowing what to expect can help make your road to recovery after VNS surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Depending on your condition after surgery, you may go home the same day or you may spend a night in the hospital.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes about two weeks. Your stimulator will not be active during your two-week recovery period. You will see your neurologist 2 to 4 weeks after surgery to activate and program the stimulator.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort at the surgical sites in your neck and chest. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after VNS surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
VNS therapy may cure your condition or reduce your symptoms so you can live well and enjoy an active life. Keep in mind that VNS can take time to work. In fact, your doctor may recommend waiting 1 to 2 years to see if VNS will be helpful for you. If VNS is not working for you,
How might VNS affect my everyday life?
you may opt to leave the device in place (without stimulation) or have your doctor remove it.
People who have an active VNS device need to:
Have frequent follow-up visits to adjust the dose of electrical pulses.
Learn how to use the patient magnet. The patient magnet allows you to control the VNS device by temporarily increasing the pulses or pausing stimulation.
Notify all your healthcare providers about your VNS device. You may not be able to have certain procedures such as MRI.
Undergo minor procedures in the future to replace the battery when it wears out. Batteries typically last 5 to 10 years.