Vagus nerve stimulation (VNS) is an palliative treatment (relieves symptoms, but doesn’t treat the cause) for certain types of epilepsy and major depression. VNS uses an implanted stimulator to deliver electric impulses to an electrode on the vagal nerve in the neck via a lead wire implanted under the skin. These impulses modulate the brain’s circuitry. The generator is a pacemaker, similar to ones used in deep brain stimulation to treat Parkinson’s disease, with subdermal (under the skin) leads connecting to the vagus nerve.
Since a vagal nerve stimulator activates a nerve to the brain, and not the brain itself, this is a less invasive procedure than deep brain stimulation (DBS) which requires open surgery to drill holes into the skull and to place an electrode deep inside the brain.
Stimulation of other nerves has proven effective in treating neuralgia (pain along the nerve path); for example, electrical stimulation of the trigeminal nerve has been used to successfully treat trigeminal neuralgia and neurostimulation of the occipital nerve has helped control certain kinds of headaches. Researchers are still exploring how vagal nerve stimulation regulates mood and controls seizures, but proposed explanations include an alteration of norepinephrine release and elevated levels of the neurotransmitter GABA.
Vagus nerve stimulation to treat depression
Currently, vagus nerve stimulation is FDA-approved for treatment of refractory (treatment resistant or unmanageable) depressions.
Vagus nerve stimulation as an epilepsy treatment
For those who don’t respond to medications and have seizures from more than one area of the brain, vagus nerve stimulation may be an option. This outpatient procedure may reduce the length and number of seizures. Patients who experience warnings signs of oncoming seizures can employ a magnetic device to initiate the generator and stave off the seizure.
Treatment for epilepsy resulting from mesial temporal lobe sclerosis typically involves medical and surgical therapy. Surgical therapy involves either temporal lobectomy or vagus nerve stimulation as described above.
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