Pediatric vagus nerve stimulation (VNS)

What is pediatric vagus nerve stimulation (VNS)?

Pediatric vagus nerve stimulation (VNS) is a treatment for children who have epilepsy, particularly children who have seizures that don’t respond to medication (also called intractable epilepsy).

The vagus nerve runs from the heart to the brain and helps control many internal organ functions, including breathing and heart rate.

To reduce epilepsy seizures with pediatric vagus nerve stimulation, we surgically place a small battery in the chest wall and connect it to electrodes wrapped around the left vagus nerve deep in the neck. The battery allows stimulation to be sent along the vagus nerve, signaling the brain to reduce seizures’ intensity, length and frequency.

The device works by:

• Being programmed to send out regular signals (including remote programming by our team)
• Monitoring the heartrate and sending a stimulation when the heartrate increases, which can be a sign of a seizure (often exercising heartrate elevations are different than seizure heartrate elevations)
• Manual activation (including a time-lock to prevent overuse)

What are the benefits of pediatric vagus nerve stimulation (VNS)?

Pediatric vagus nerve stimulation is not a cure for pediatric epilepsy. However, when taken with the proper medication, many children will have fewer seizures. In our experience, about half of children treated with this approach experience up to 50% fewer seizures when evaluated 2 years after the implantation of the device. Those seizures may also be less severe, shorter and with a faster recovery time.

Additionally, vagus nerve stimulation offers peace of mind. Because you can manually activate the battery, you can step in as soon as your child starts seizing. The device also has built in safeguards to prevent overuse (overstimulation).

It can take some time before your child sees the full benefit of vagus nerve stimulation (although some children may experience a “honeymoon” period where it seems like seizures have disappeared immediately after placement).

With the addition of new medications, the seizures often can settle in the short term then recur. With VNS the seizures often slowly settle over time. Our team of brain specialists (neurologists) will work with your child to find the ideal combination of medication and device programming that works best for them.

Treatment results may include:

• 50% decrease in seizure duration or frequency
• 50% of patients experiencing benefits
• 2 years of treatment before experiencing full benefits

What are the side effects of pediatric vagus nerve stimulation (VNS)?

Most of the side effects of the pediatric vagus nerve stimulation procedure are mild. Often these side effects are only present when the device is stimulating the nerve, and will become more tolerable with time.

Your child may experience no side effects, or they may experience:

• Throat pain
• Hoarseness
• Voice changes
• Cough
• Shortness of breath
• Trouble swallowing
• Headaches

What are the risks of pediatric vagus nerve stimulation (VNS)?

Like all surgeries, pediatric vagus nerve stimulation has some risks, though they are uncommon.

Our team will discuss the following risks with you and how we manage them, including:

• Pain at the surgical site
• Infection
• Difficulty swallowing
• Vocal cord complications

The VNS generator has a battery life or up to 5-10 years before it will need to be changed. This will depend on the stimulation settings.

What can I expect with pediatric vagus nerve stimulation (VNS)?

The procedure to place the pediatric vagus nerve stimulation device will take about an hour and a half (and add another 90 minutes for going to sleep and waking up before and after the procedure).

What can I expect before pediatric vagus nerve stimulation (VNS)?

During the procedure, we will give your child medication to help prevent infection (antibiotics) and medication to help them stay asleep during the procedure (anesthesia).

What can I expect during pediatric vagus nerve stimulation (VNS)?

Your child’s surgeon will make 2 small incisions (cuts) during the procedure, one near the left armpit and one on the left side of the neck. They will expose the vagus nerve, then loop the wires around this nerve and close the incision.

Next, they will attach the battery/generator to the wires that have been placed under the skin to the armpit incision and position the small battery device into the chest wall. All incisions will then be closed.

What can I Expect after pediatric vagus nerve stimulation (VNS)?

You and your child will stay with us overnight so that we can observe and monitor their health. After the procedure, most children feel a small bump under the skin near the device, while others don't feel the device at all.

Examples include:

• How many vagus nerve stimulation procedures have you performed?
• Will my child need to spend the night at the hospital after the vagus nerve stimulation procedure?
• Are there other treatment options for medication-resistant (intractable) epilepsy?
• What medications should my child stop taking before the vagus nerve stimulation procedure?
• Will my child go home with any special equipment after the vagus nerve stimulation procedure?
• How soon will I be able to see my child after the vagus nerve stimulation procedure?
• When will the device be turned on?