Prof. Dr. Mete Karatay, Head of Brain and Nerve Surgery Department, YYÜ Gaziosmanpaşa Hospital shared important information by stating that apart from keeping this disease under control with the help of anti-seizure strategies and various drugs for epilepsy patients, it is possible to treat with VNS surgical treatment known as ‘Vagus battery’ or ‘Epilepsy battery’.
‘Epilepsy’, popularly known as ‘falling sickness’, is a chronic (long-term) disease. It is known that epilepsy causes involuntary contractions, sensory changes and changes in consciousness in the patient due to the sudden and uncontrolled discharge of neurons in the brain, while it significantly affects the quality of life of the person.
Stating that the breaking new ground of the century in Brain and Nerve Surgery, Prof. Dr. Mete Karatay stated that this surgery is hope, especially for epilepsy patients who are resistant to drugs and cannot benefit.
What is the vagus nerve?
The vagus nerve, which is a part of the nervous system, provides communication between the brain and the heart, and it also has connections with the intestine, kidney, gall bladder, lung, liver, pancreas, neck, tongue and ears. Starting from the brain and coming from both sides of the neck, it enters the rib cage, where it divides into different branches. The vagus nerve, which transmits the commands of the brain to both the heart and the internal organs, regulates the working system of the body.
In patients with epilepsy, the vagus nerve is stimulated to ensure proper functioning of the system. Electrodes placed on the vagus nerve passing through the neck region give electricity to the nerve at regular intervals. In this way, epileptic seizures are partially or completely stopped.
Who does VNS apply to?
Vagal nerve stimulation is applied to epilepsy patients. Patients who do not respond to long-term drug therapy and whose epileptic seizures continue are suitable for epilepsy surgery. Patients who are candidates for surgery should use epilepsy drugs regularly within the specified period and the dose should be sufficient. The brain of these patients should also be free of tumors or other masses that may pose a problem during surgery.
Vagal nerve stimulation (VNS) application is performed in patients who are resistant to drug therapy, as well as in patients who cannot undergo surgery or whose seizures continue after surgery.
Who does not apply VNS to?
1) Epilepsy patients who respond to drug treatment,
2) Patients with a tumor or a different mass in any part of the body,
3) Patients with various ailments, especially rhythm disorders in the heart,
4) Patients who have an infection in any part of their body,
How is the surgery performed?
The vagal nerve stimulator, which is applied to partially or completely prevent seizures in epilepsy patients, is performed under general anesthesia. Electrodes, which will give electricity at regular intervals, are wrapped around the vagus nerve, which passes through the neck region, during the operation, which usually lasts for 1-2 hours. With these electrodes connected to a battery source, it is aimed to suppress the abnormal activities seen in the brain. The battery source is usually placed under the collarbone. One of the important points that should be known in the application of Vagal nerve stimulation is that the application does not eliminate the disease itself, but only partially or completely eliminates the symptoms.
What are the risks of VNS surgery?
1) Risk of infection
2) Vagal nerve damage
When the vagus nerve is damaged, symptoms such as hoarseness can also be permanent. However, vagus nerve complications are an extremely unlikely risk. There are no complications, especially in operations performed under the control of specialist surgeons.
After the operation, epilepsy battery malfunctions can also cause some physical symptoms. The electric current given by the battery, which cannot fulfill its task, can cause discomfort such as pain in the neck region, cough, sleep apnea, hoarseness and shortness of breath.
Complete discharge of the battery is also among the risks, but it is an expected situation. Depending on the brand and model of the batteries, the usage times vary. At the same time, applying a high or low setting is also one of the factors that affect battery life. In cases where the battery is completely depleted, patients need to be operated again.
Frequently asked questions about VNS surgery
To which epilepsy patients is the Vagal nerve stimulation applied?
Pil (battery) treatment is suitable for patients who are resistant to drug therapy and whose seizures continue after surgery. Patients who still have seizures despite ongoing treatment with at least two drugs are fitted with a pacemaker. At the same time, patients who are not suitable for surgery also benefit from this method.
What is the success rate in Vagal nerve stimulation treatment?
Vagal nerve stimulation application gives very positive results in most patients. The frequency of seizures was reduced by half in approximately 50% of the patients. Complete recovery was achieved in a group of 5% of patients.
Does Vagal nerve stimulation cure epilepsy completely?
Vagal nerve stimulation is not applied to cure epilepsy but to stop seizures partially or completely; The goal is to eliminate the symptoms, not the disease itself. While seizures stopped completely in some patients, a significant reduction in seizures was observed in some patients. It is not predictable to what extent the Vagal nerve stimulation operation will improve the patient. The effects show themselves after the operation.
Can those who have undergone Vagal nerve stimulation surgery benefit from imaging methods?
Patients with epilepsy pacemaker should consult specialist physicians before undergoing imaging methods such as Magnetic Resonance (MR). Some patients can undergo MRI if necessary safety precautions are taken. In some patients, a surgical procedure is required before MRI. The electric current provided by the battery is turned off, and the patient is taken to the MRI, and then the current is turned on again. It is also an important point that patients should not be taken into the MR room, especially when the magnets are working.
Do patients feel it when the battery is activated?
Most patients have very minor, almost imperceptible symptoms when an electrical current is applied. A slight tingling sensation and hoarseness are the most common symptoms. These symptoms begin to be felt much less after prolonged use of the battery.