Vagus nerve stimulation -
- intractable epilepsy therapy
Doc. MUDr. Eva Brichtová, Ph.D.
Dpt. of Neurosurgery
St. Anne University Hospital Brno and Masaryk University Brno
Epilepsy Center Brno

Nervus vagus stimulation
•Long-term vagus nerve stimulation (VNS) is a palliative treatment method for inoperable refractory
epilepsy
•
•First implantation in humans in 1988
•The first implantation in Czech Republic in 1997
•
•Nowadays about 60,000 patients
•
•Czech Republic about 500 patients
•

Indication
•The VNS Therapy System is considered as supportive therapy
•
•to reduce the frequency of seizures
•
•in epileptic patients non-responding to antiepileptic drugs
•
•with partial seizures (with or without secondary generalization) or generalized seizures
•

The method utilizes the ability of afferent vagus nerve fibres to transmit nerve impulses into the
brain stem nuclei (especially the solitary tract nucleus) and in this way further into the the
limbic system and thalamo-cortical circuits.
Mechanism of VNS effect

VNS implantation
The principle - electrical stimulation of the left vagus nerve
through the bipolar electrode, which is connected to
implantable pulse generator in the subclavian area.

VNS implantation



VNS implantation



VNS implantation procedure



Neurochirurgie patru; https://www.youtube.com/watch?v=T_W5WNgyR6M
VNS implantation procedure


VNS implantation procedure



Setting VNS therapy parameters
Typical stimulation parameters:
Current output: 1.0 to 2.0 mA   Frequency:          20 Hz or 30 Hz
Pulse width:       250 or 500 us
Time ON stimulation: 30s Stimulation OFF time: 3 or 5min
using programming computer  and
            programming wand

63% responders after 1 year, 55% after 2 years
Kuba R. 2002 Neurologie pro praxi
The effect of VNS therapy
 Reduction in number and intensity of seizures
Patients with at least to 50%
seizure reduction
(adult pts)

ČESKÁ REPUBLIKA

Brno
Brno dětská
NNH
FNM dětská
FNM  dosp.
NNF
FTN dětská
FTN  dosp.
∑
∑
∑

primo
re
primo
re
primo
re
primo
re
primo
re
primo
re
primo
re
primo
re
primo
re

1997










1

1



2
0
2
1998






1









1
0
1
1999
17



8

1



6

2



34
0
34
2000
12



8

2



2

2
1


26
1
27
2001
9



4

6
2
1

1

4



25
2
27
2002
11





2





2

3

18
0
18
2003
9
5


6
1
5

8

4
3
3

1

36
9
45
2004
10
4


13
1
1

1

3
3
5

1

34
8
42
2005
11
3


3
2
1

1

1

1

1

19
5
24
2006
17
3


9
9
5



1

2



34
12
46
2007
13
2


3
4
1

4
1
1




1
22
8
30
2008
10
1
2
0
3

1

3

4



3

26
1
27
2009
17
3
2
0
7

4

7
1
3

2
2
2

44
6
50
2010
12
10
4
0
4
3
3

3
1
4
1
3
1

2
33
18
51
2011
18
8
2
0
6
5
4
0
3
1
1
0
0
0
1
4
35
18
53
2012
11
12
1
0
6
5
3
0
2
4
4
1
0
0
0
1
27
23
50
2013
13
5
3
1
4
4
1
1
4
4
5
4
0
0
0
2
30
21
51
2014
10
7
2
2
6
6
4
0
3
2
4
2
0
0
1
6
30
25
55
2015
8
17
3
2
5
7
2
1
3
2
2
1


1
4
24
34
58
2016
1
2
1













2
2
4
∑
209
82
20
5
95
47
47
4
43
16
47
15
27
4
14
20
476
157
633


 VNS therapy in Czech republic

Quality of life and VNS Therapy
Lethargy
Drowsiness
Difficulty
 thinking
Depresion
Memory loss
      Patients with refractory epilepsy
(n=503)
        Quality of life and VNS Therapy
(n=2 229)
              % of pts reporting
% of pts with improvement or
significant improvement
  3  Months
12  Months
  Activity
  Postictal state
  Seizure cluster
  Verbal skill
  Mood
  Study results
  Memory

Kontakt:
eva.brichtova@fnusa.cz
Fakultní nemocnice u sv. Anny v Brně
Pekařská 53, Brno 656 91
Česká republika
Tel:  + 420 543 181 111

 www.fnusa.cz
http://www.healthline.com/hlcmsresource/images/topic_centers/depression/HelpForDepression/194x105_V
NS.jpg