Type of Surgery
Last updated: 02/17/2009
Epilepsy affects about 1% of people in the general worldwide population. Approximately 40% of patients do not respond well to medications, however, and so may be candidates for surgical treatment. Vagus nerve stimulation was first performed in the...
United States in 1988 and received final approval by the United States Food and Drug Administration (FDA) in July 1997. Approximately 10,000 people worldwide have had stimulators implanted as of 2003; about a fifth of these patients are children 12 years old and younger.
Vagus nerve stimulation (VNS) is an adjunctive treatment for certain types of intractable epilepsy and major depression. VNS uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin.
Vagus, the tenth cranial nerve arises from the medulla and carries both afferent and efferent fibers. The afferent vagal fibers connect to the nucleus of the solitary tract which in turn projects connections to other locations in the central nervous system. Little is understood about exactly how vagal nerve stimulation modulates mood and seizure control but proposed mechanisms include alteration of norepinephrine release by projections of solitary tract to the locus coeruleus, elevated levels of inhibitory GABA related to vagal stimulation and inhibition of aberrant cortical activity by reticular system activation
Select comparative data from 1999 to 2006 include a decrease of 14 percent in the number of neurosurgeons in private practice and a decrease of 13 percent in the number of neurosurgeons in solo practice.
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