Vagus Nerve Stimulation
Vagus
nerve stimulation (VNS) is an exciting new technique available at
the New York Hospital-Cornell Comprehensive Epilepsy Center .
Vagus
nerve stimulation is a type of surgery for poorly controlled seizures,
but does not involve surgery on the brain. A small pacemaker-like
device is placed under the skin, and periodically stimulates a nerve
(the vagus) in the side of the neck with a small amount of electrical
current. This process reduces seizure frequency and severity. The
vagus nerve serves as one of many highways of information carrying
messages to and from the brain. Nerve fibers in the vagus nerve
relay information from the body's organs (such as the stomach and
heart) to the brain. The vagus nerve has many connections to areas
in the brain instrumental in producing seizures.
Research
in animal models suggested that stimulation or electrical activation
of the vagus nerve can disrupt the abnormal brain activity responsible
for seizures. By stimulating the vagus nerve, the brain's potential
to generate or spread abnormal seizure activity can be reduced.
These
important findings led researchers to create a small, implanted
device which would provide stimulation of the vagus nerve on a regular,
programmed basis - with the aim of reducing seizure frequency and
severity.
A device,
approximately the size of a small tape measure, is implanted under
the skin in the upper left chest area. This device, known as the
generator, functions as the "pacemaker". A connecting wire, also
implanted under the skin, connects this "pacemaker" with the vagus
nerve, by delicate leads which are carefully attached to the vagus
nerve on the left side of the neck.
The
operation to implant a vagal nerve stimulator takes approximately
two hours. Over the next two days, the vagal nerve stimulator is
programmed to automatically deliver stimulation on a regular, frequent
basis, usually every few minutes, around the clock. All vagus nerve
stimulators are produced by Cyberonics, Inc.
After
extensive clinical trials, vagus nerve stimulation is now FDA approved,
and available at specialized epilepsy centers such as ours. The
Comprehensive Epilepsy Center at The New York Hospital-Cornell is
the most active and experienced center with VNS treatment in the
Mid-Atlantic region. In Europe, vagus nerve stimulation has been
available for all appropriate patients at specialized centers for
several years.
Most
of the clinical trials for vagal nerve stimulation focused on patients
with partial seizures. However, we have just published the results
of our experience here at New York Hospital-Cornell, which suggests
that VNS is extremely helpful for generalized epilepsies, as well.
Trials
currently in progress are examining details of different stimulation
frequencies and settings, in an effort to rigorously establish guidelines
for most efficacious seizure control.
For
further information about vagus nerve stimulation or other exciting
treatment options, please contact:
Douglas
Labar, MD, PhD, Director,
Comprehensive Epilepsy Center
(212) 746-2359
epilepsy@med.cornell.edu
Theodore
Schwartz MD, Director,
Center for Epileptic Surgery
(212) 746-5620
epilepsy@med.cornell.edu
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