Vagus Nerve Stimulation Therapy for Epilepsy

Last Modified: June 11, 2020  |   Created on: November 13, 2019
Brain

Cost of Vagus Nerve Stimulation

Vagus Nerve Stimulation cost in India ranges from USD 28000- 33000. This includes the cost of Vagus Nerve Stimulation device and the surgery to implant the device.

For precise quotes of VNS therapy cost in India and a treatment plan, share medical reports or send your query at care@lyfboat.com.

What is VNS therapy?

Vagus nerve stimulation (VNS) therapy is a treatment for epilepsy that involves the use of a stimulator to send electrical pulses to the vagus nerve in the neck. The aim of VNS therapy is to prevent or stop seizures, reduce the intensity and frequency of seizures in some patients. It is also a treatment for depression.
In this therapy, a pacemaker-like device is surgically implanted under the skin of the chest and the wire is threaded under the skin and woven around the vagus nerve in the neck. The treatment is delivered through this device (pulse generator) which stimulates the vagus nerve with regular, mild electrical pulses in an effort to control the irregular electrical brain activity which causes seizures.
VNS Therapy is a safe and well tolerated treatment method. It is not a drug and therefore doesn’t have the same side-effects. It is an add-on therapy and does not interact with other medications.

Vagus Nerve Stimulation

Highlights:

  • Vagus nerve stimulation therapy is a treatment for people with epilepsy who do not respond well to medications alone.
  • VNS Therapy is administered through a medical device that sends mild electrical pulses to the vagus nerve at regular intervals throughout the day
  • The Food and Drug Administration (FDA) in the USA has approved use of VNS as an additional therapy for adults and children who are 4 years of age or older.
  • It is used to treat focal or partial seizures that are not controlled by seizure medications. This condition is known as drug-resistant epilepsy or refractory epilepsy.
  • VNS therapy has also been approved by the FDA as a treatment of people with chronic or hard to treat depression and who haven’t responded to four or more medications, psychological counselling or electroconvulsive therapy (ECT).
  • It involves a short outpatient procedure, which takes about 1-2 hours to complete.
  • The procedure is not a brain surgery.

What are the vagus nerves?

The vagus nerve is located between the carotid artery and the jugular vein in the neck. It starts in the brain and reaches to abdomen, passing the major organs in the body. The vagus nerve is a primary line of communication that carry messages between the brain and the body. It is a part of the autonomic nervous system that controls involuntary functions of the body, such as heart rate and breathing.

Who needs it?

Most people with epilepsy are treated with medications called anticonvulsant or anti-seizure drugs. But these medications may not work in some people or they are unable to tolerate the side effects. This may happen when the seizures are being produced throughout your brain or the medications are unable to control them. Research data suggests that for about one in three individuals with epilepsy, the seizures are difficult to be treated with medication alone (Drug resistant epilepsy or DRE). Another option of treatment is surgical intervention to remove the part of the brain that causes seizures. However, not everyone is a candidate for surgery. 

That’s where VNS comes in. It has proven to be an effective adjuvant treatment that has been approved by the FDA and indicated for people who:

  • Are 12 years of age or older
  • Suffer from focal (partial) epilepsy
  • Have seizures that aren’t responding to antiepileptic medications (DRE)
  • Suffer from chronic, hard-to-treat depression (called treatment-resistant depression)
  • Do not show improvement in depression after the use of four or more medications, along with psychotherapy or electroconvulsive therapy (ECT)

For these people, standard depression treatments is continued with vagus nerve stimulation.

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What complications can occur due to uncontrolled seizures?

  • Uncontrolled seizures in epilepsy can be very stressful and unsettling for children and adults. Some of the consequences related to this are:
  • Disrupt critical periods of brain development in infants and children
  • Interfere with important processes related to learning and memory (most serious in infants)
  • Accidents or injuries can happen during seizures
  • It can be life-threatening (epilepsy related premature death)

How is it performed?

  • You will be put under general anesthesia before the procedure.
  • The doctor will make two small incisions: one on the lower left side of the neck and other along the left side of the chest.
  • The VNS device, which is a small round battery powered device, will be implanted beneath the skin in the upper part of your chest.
  • Then the wire is tunneled under the skin toward the left side of the chest and small platinum electrodes are wrapped around the vagus nerve. The leads of the electrodes are connected to the generator, and the system is tested before closing the incisions.
It takes one to two hours to complete the procedure and the patient can return home the same day or the next, after a short overnight stay. The patient is further assessed for seven to 10 days for a wound infection. The neurologist will explain how to use a magnet wand to control a seizure.

How does VNS work?

After implantation, the stimulator is usually switched on within four weeks after the surgery. The neurologist programs the stimulator to generate electric pulses at regular intervals and amount (strength and length) of the electrical stimulation is set depending on how much you can take. The setting is adjustable and the amount of stimulation may vary from person to person. However, it usually starts from a low level and is gradually increased to a suitable level for each individual. Generally, settings are made for 30 seconds of stimulation every five minutes, day and night. To control the seizures, the magnet wand is waved over the pulse generator. This leads to generation of an immediate electric current which may stop the seizure in progress or reduce its severity. The magnet is carried by the patient at all times, usually by wearing it on the belt or around the wrist. The stimulator battery can last up to ten years and when the battery gets low, the stimulator has to be replaced. This requires an operation similar to the previous one to put in the device.

How can Lyfboat assist you getting Vagus Nerve Stimulation in India?

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Lyfboat is a free advisory platform; we do not charge any fees from patients. In fact, we negotiate the price that Indian hospitals offer. In some cases we are able to reduce the cost by negotiating upto 20% of what Hospitals generally offer. We advise the best treatment from the top hospital/surgeon at best price.

How does it help with seizures?

Vagus nerve stimulation (VNS) therapy is a type of neuromodulation technique. The therapy is designed to impact how brain cells work by providing electrical stimulation to particular areas of the brain that are involved in seizures. The vagus nerve is an important pathway to the brain. It sends messages from the brain to other areas of the body and also carries information from the body to the brain. Although, the doctors do not know for sure how VNS works, it is thought that VNS may help control seizures by:
  • Stimulating the vagus nerve may send electric pulse to a wide area of the brain. This disrupts the abnormal brain activity, which cause seizures
  • Increasing the blood flow in key parts of the brain
  • Increasing the levels of brain substances called neurotransmitters which are important to control seizures
Studies have shown that 8 out of 10 people with epilepsy may have an increased heart rate before a seizure. The new VNS models detects a fast increase in heart rate and triggers an extra burst of stimulation (additional dose) to help control the seizures.

What are the expected results of VNS therapy?

Results may vary for different individuals. The aim of the VNS therapy is to reduce the number, length, and severity of seizures in people with epilepsy.

The effect of VNS therapy may not be seen right away as it can take up to two years to have an effect on seizures. The therapy is used in combination with anti-epileptic drugs (AEDs). However, VNS therapy can reduce a person’s dependency on anti-epileptic medications  over time.

Some people may experience less frequent seizures after VNS implantation, or it may reduce their seizures a little for others. For some, it may also reduce the recovery time after a seizure. However, VNS therapy is unlikely to stop the seizures completely and is not a ‘cure’ for epilepsy.

What are the benefits of using VNS?

  • Reduce the intensity of seizures
  • Reduce the frequency of seizures over time
  • Improve the recovery time after a seizure
  • Limit hospital visits
  • Reduce the risks associated with uncontrolled epilepsy
  • Programmed dosage is delivered automatically (set up by the doctor once)
  • It has also shown improvement in mood, alertness and memory of epilepsy patients.

What are the potential side effects of VNS therapy?

VNS therapy can cause certain side effects but usually only during the time period when the nerve is being stimulated. Not everyone experiences the side effects and in those who do they may reduce over time. The most common side effects associated with VNS Therapy are:

  • Hoarseness
  • Coughing
  • sore throat
  • Tingling in the neck
  • Trouble swallowing
  • shortness of breath

Generally, the stimulator does not need to be switched off. If a person is having problems with the side effects, the neurologist will adjust the settings, or advice to hold the magnet over the stimulator for a few seconds in order to briefly stop the stimulation. VNS therapy does not affect, and is not affected by, anti-epileptic drugs.

What are the risks?

VNS therapy, like every surgical procedure, has some risks. These include risk of infection, bleeding, allergic reaction to anesthesia and injury to the nerve or nearby blood vessels, such as carotid artery and jugular vein.

Frequently asked Questions (FAQs) about Vagus Nerve Stimulation Therapy for Epilepsy

Q. Can I have an MRI scan with the VNS device?

The latest VNS therapy technology is MRI-safe. But, before scheduling your MRI, you should discuss it with your neurologist. It is also important to inform the centre or the doctor who is involved in the scan. You can provide the model number of your implanted VNS device, and also the name and contact information of your neurologist.

In some cases, extra care may be needed or the stimulator may need to be switched off for the scan. It can be turned back on again after the scan.

The magnetic fields in an MRI can cause the leads of the device to overheat, resulting in burns to the skin near the electrodes or leads. The risks also depend on the MRI machine used and the type of scan you need.

Q. Do X-ray and CT scans also affect the VNS therapy device?

VNS therapy device is not affected by X-rays and CT scans nor do they get affected by VNS device. The reason for this is that they do not produce enough radiation to damage the stimulator.

Q. Will I be able to go through security at the airport with my VNS therapy device?

Yes, you can. Metal detectors and anti-theft devices should not affect VNS Therapy device. But you should provide your VNS Therapy ID card to the security officers at the airport to inform that you have an implanted medical device. Also, request a pat down check instead of the security wand.

Q. Will household appliances affect VNS therapy device?

Generally the electrical and electronic devices used in houses, including microwaves, ovens, toasters, hair dryers and cell phones do not affect the implanted device. You will receive a full list of warnings and precautions for your VNS device. You should be cautious around the appliances that generate strong electric or magnetic signals and keep them 15 cm away from the area where the device is implanted.

Q. Who is considered for VNS therapy?

VNS therapy is usually indicated for those who have tried a number of anti-epileptic drugs but have not fully controlled the seizures. It is also an option for those who are not suitable for or do not want to have a brain surgery.

To obtain detailed information about your case, it is best to talk to a neurosurgeon.

Q. What are the things that you should keep in mind with VNS therapy?
  • It has not been established how safe and efficient VNS Therapy is for use during pregnancy. Smoke can increase the risk of laryngeal irritation.
  • Proper care and antibiotics must be taken to prevent infection that may lead to removal of the device.
  • VNS Therapy system can affect the operation for other implanted devices, such as cardiac pacemakers and implanted defibrillators.
  • Some of the possible effects also include sensing problems or inappropriate device responses.
Vanshika Rawat

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is very knowledgeable in the field of science and healthcare and has worked under brilliant scientists during her higher education. Vanshika obtained her degrees in Masters in Science and Bachelors in Science (Microbiology with Hons.) from renowned institutions - Panjab University and University of Delhi.
Dr. Surbhi Suden

Verified By Dr. Surbhi Suden

Dr. Surbhi Suden is one of the founders of Lyfboat and a doctor with a renowned name in the Medical tourism industry. She has been working with international patients since 2008 and is a deeply committed professional with a long term vision of transforming the current healthcare scenarios.

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