VNS

At the Brno Epilepsy Center, we have extensive experience with Vagus Nerve Stimulation (VNS), with the first implant performed in 1999.

How Is the VNS Implant Procedure Performed?

VNS implantation is not a brain surgery, but rather a minimally invasive and relatively short surgical procedure. During the operation, the neurosurgeon makes two small incisions—one on the left side of the neck, and another just below the collarbone.

Through these incisions electrodes are carefully placed around the vagus nerve in the neck. The VNS generator (containing a battery) is implanted beneath the skin under the collarbone.The electrodes and generator are connected by a thin, flexible wire, which transmits small electrical pulses to the vagus nerve, helping to modulate brain activity.

Although the exact mechanism by which VNS reduces seizures is not fully understood, it has been shown to be an effective option for many patients with drug-resistant epilepsy.

The procedure is performed under general anesthesia.

What Will the Implant Look Like?

After surgery:

• A small scar may remain on the neck.
• A slight bulge may be visible under the collarbone where the generator is implanted.
• The stimulator itself is discreet and generally not noticeable.

How Long Does the Surgery and Hospital Stay Take?

You will be admitted to the Department of Neurosurgery one day before the surgery.
The procedure itself takes approximately 45 to 90 minutes, and you can expect to be discharged within a week after the operation.

What Does Follow-Up Treatment Look Like?

After the VNS device is implanted, your physician will program the stimulator to deliver regular electrical impulses to the vagus nerve—24 hours a day, 7 days a week, in preset cycles.

Stimulation is typically started at a low level to monitor your response and assess for any side effects. Based on how you tolerate the stimulation, your doctor will gradually adjust the settings over time.

You will be seen for regular follow-up appointments:

• Every two weeks initially
• Then less frequently, typically every few months once the optimal settings are established

Adjustments to the VNS settings are painless and are made by placing a handheld programming device over the area where the stimulator is implanted (just under the skin near the collarbone).

As part of the therapy, you will also receive a magnet wristband. By briefly placing the magnet over the implanted generator, you may be able to stop a seizure from progressing, shorten its duration, or lessen its intensity. However, the magnet is not needed for routine stimulation, which occurs automatically.

When Can I Expect to Feel the Effects?

Successful VNS therapy typically results in a reduction in seizure frequency or intensity, although the response is highly individual. The optimal effect of stimulation may take several months to one or even two years after surgery to become fully apparent. In many cases, the benefits of stimulation do not diminish over time—in fact, they may gradually improve.

In addition to seizure control, VNS therapy can have a positive overall impact on quality of life. Many patients report improvements in mood, alertness, and memory.

If VNS therapy proves ineffective—meaning it does not reduce seizure frequency or severity—the device can be turned off or surgically removed if needed.

Importantly, VNS implantation does not interfere with future treatment options, including new medications or surgical procedures. MRI scans can be performed with an implanted VNS device, but the stimulator must be turned off before the procedure.

Risks and Side Effects

The most common side effects of VNS therapy include hoarseness or voice changes, coughing, throat tickling, and shortness of breath. These side effects typically occur during stimulation and tend to lessen significantly over time.

Both VNS therapy and the associated implantation procedure are considered highly safe. Surgical risks are low but may include complications such as infection at the site of the implant.