Type of Surgery
Last updated: 02/17/2009
Vagal nerve stimulation is an alternative to medication or surgical removal of brain tissue in controlling epileptic seizures. The seizures of epilepsy are caused by uncontrolled electrical discharges spreading through the brain. Anti-seizure drugs...
interrupt this process by reducing the sensitivity of individual brain cells to stimulation. Brain surgery for epilepsy either removes the portion of the brain where seizures originate, or cuts nerve fibers to prevent the nerve impulses that occur during a seizure from spreading to other parts of the brain. Vagal nerve stimulation uses a different approach; it provides intermittent electrical stimulation to a nerve outside the brainâ€”the vagus, or tenth cranial nerve, which influences certain patterns of brain activity.
The vagus nerve is a major connection between the brain and the rest of the body. It carries sensory information from the body to the brain, and motor commands from the brain to the body. The vagus is involved in complex control loops between these destinations; its precise pathways and mechanisms are still not fully understood. It is also not known how stimulation of the vagus nerve works to reduce seizure activityâ€”it may stimulate inhibitory pathways that prevent the brain's electrical activity from getting out of control, interrupt some feedback loops that worsen seizures, or act in some other fashion.
Vagal nerve stimulation has been effective in reducing seizure frequency in patients whose seizures are not controlled by drugs, and who are either not candidates for other types of brain surgery or who have chosen not to undergo these procedures.
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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