Department of Neurology

Is my son a good candidate for vagus nerve stimulation?

Q: Looking for some advice .... my son is 18 1/2. He was diagnosed with epilepsy 2 1/2 years ago. Has been on many different medications but the side effects, in all cases but his current medication, were unacceptable. He has been on Lamictal by itself for over a year. Currently, his daily dosage is 600 mgs. He rarely has small seizures any more, but has had 3 grand mal seizures - the first one occurred last December, the second in May and the third in August. Because of his intolerance for Depakote, (and others), we are running out of options and today his doctor gave us information on vagus nerve stimulation (VNS). Everything I can find on the web states it has proven very helpful for partial seizures - has it yet been tested on patients like my son? And, if so, are the results encouraging?

Your reply will be very much appreciated!

Bobbi


A: There have been two major trials for vagus nerve stimulation that studied its efficacy in persons with medically refractory partial-onset seizures. Their ages were greater than 12 years and most were on two to three medications. Thus, persons with these characteristics have been considered to be good candidates. From what you describe, your son would fit these criteria well.

Our center was part of both major clinical trials and have had patients on this therapy since 1990 and so we have had a large amount of experience with VNS. Its main attributes are its very low side effects and excellent tolerability. Over the long run, it appears that about 40% of people with medically-resistant epilepsy will have at least a 50% reduction in their seizure frequency. Whether VNS therapy should be utilized before or after brain surgery is still debated. Some feel that given the excellent control of seizures by epilepsy surgery, vagus nerve stimulation should be used as a last resort. Other physicians and patients, noting the low complication rate with implantation of the device and low side effects during therapy, have advocated using vagus nerve stimulation sooner.

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