One of Germany's largest hospitals, made up of more than 50 clinics and specialist institutes spanning all medical specialties. Kinikum Stuttgart is regarded as one of the best hospitals in Germany, and is a referral center for oncology, ENT, pediatrics and more.
The University Medical Center Freiburg is one of the largest medical facilities in Europe and part of the Albert Ludwigs University Freiburg, one of five outstanding centers of academic excellency in Germany.
What is Vagus Nerve Stimulation?
Vagus nerve stimulation is a method of epilepsy treatment. It requires a surgical procedure in which a device like a pacemaker is implanted in the body, which generates electric pulses to stimulate the vagus nerve. Vagus nerve stimulation is done to decrease the severity, length, and number of seizures in a patient. In some cases, the frequency of the seizures is also reduced. However, it does not affect some patients and it cannot completely cure epilepsy.
Vagus nerve stimulation is used along with antiepileptic mediation. Its effect is experienced only after a long period of time.
How Does a Vagus Nerve Stimulator Work?
The vagus nerve stimulator is a computer programmed device. It is implanted under the patient’s skin below the left collar bone. This is connected to the vagus nerve in the left part of the neck. After 4 weeks from the implantation, the stimulator is switched on. It is programmed by the doctor with the help of a portable hand-held computer. The doctor sets the stimulator to give the required amount of stimulation, which varies for different patients. It is usually initiated at a low level and then enhanced to the required level for an individual patient. The common setting of the stimulator is 30 seconds of stimulation per 5 minutes. The stimulator is battery operated and has a validity of maximum 10 years. When the battery life diminishes, the stimulator should be replaced.
The vagus nerve stimulator can be used to provide extra stimulation before or during a seizure. This is done by moving a special magnet over the stimulator that can stop a seizure from occurring, or reduce a seizure that is already occurring. The magnet can be carried by the patient at all times by wearing it on the belt or around the wrist.
How is a Vagus Nerve Stimulation Surgery Performed?
An incision is made on the left side of the patient’s chest, below the collar bone. The stimulator device is implanted in this area under the skin. The implanted stimulator is a round device that usually measures about 1.5 inches (4cm) in diameter, and 10 to 13 mm in thickness. New models of this device may be smaller. A horizontal incision is then made in the lower neck and the wire from the stimulator is coiled around the vagus nerve that lies in the left side of the neck. Stimulation is only provided on the left vagus nerve, as the right vagus nerves helps to control heartbeat. A small bulge may appear on the skin after the stimulator has been implanted.
What are the Necessary Preparations for the Surgery?
Many tests may be performed on the patient to find out the focal point of the seizures. These tests include
Neuroimaging
Psychological tests that determine the patient’s cognitive potentials and weaknesses
The patient will be explained in detail about vagus nerve stimulation.
About Vagus Nerve Stimulation
Key facts to plan your treatment: how long it takes, your hospital stay, anaesthesia, risks and recovery.
Duration of surgery/treatment
Approximately 2 hours
Days admitted
Vagus nerve stimulation is done either as an inpatient or an outpatient procedure. As an inpatient, the patient will stay overnight in the hospital.
Anesthesia
General anesthesia
Recovery
- Pain medication may be provided by the doctor if required.
- Vagus nerve stimulation is usually successful in reducing 50% of the seizures.
- The settings of the stimulator are adjustable and follow-up visits may be scheduled to adjust it to the accurate settings.
- The patient will be taught how to use the magnet to increase stimulation temporarily.
- When the battery of the vagus nerve stimulator runs out after many years, the implant will be replaced in an outpatient procedure.
Risks
The risks of the surgery include:
- Injury to the surrounding blood vessels, e.g. carotid artery and jugular vein
- Infection
- Bleeding
- Allergy to anesthesia
The side effects associated with vagus nerve stimulation are mild and temporary. They include:
- Hoarseness
- Coughing
- Discomfort in the throat
- Swallowing difficulty
- Tingling sensation in the neck
- Headache
- Ear pain
The settings of the stimulator may be adjusted by the doctor if the side effects persist.
After care
- Patients who have vagus nerve stimulation implants should avoid powerful magnets that may affect the settings of the stimulator.
- If patients are required to do Magnetic Resonance Imaging (MRI), they must inform about their vagus nerve stimulation implant. If the doctor allows the MRI to be performed on patients with stimulator implants, the stimulator needs to be switched off prior to the scan.
- Patients should avoid areas which have warning sign posts for pacemakers.
- The doctor’s instructions on safety precautions should be followed carefully.
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