REFRACTORY EPILEPSY AND VAGUS NERVE STIMULATION: THE WAY FORWARD

Abstract

Vagus Nerve Stimulation (VNS) an efficacious neurophysiological modality of treatment for both medically & surgically refractory epilepsy was first implanted in 1988 & later approved by US FDA in 1997. In clinical practice, trains of current are applied intermittently to the left vagus using a pacemaker or AICD like device 'the VNS device'. The device has four components pulse generator, lead, spiral electrodes & a magnet. The pulse generator is implanted beneath left clavicle by a simple surgical method & attached to left vagus nerve via lead & spiral electrodes.[1] The magnet provides an extra edge to control the aura or impending seizure by providing 'On Demand' stimulations. The poor cardiac innervation by left vagus helps to minimize the unwanted or at time dangerous side effects like severe bradycardia, brady arrythmia, or even cardiac asystole.[2]