IU Physicians To Perform State’s First Vagal Nerve Stimulation Procedure For Epilepsy

INDIANAPOLIS -- A team of surgeons and neurologists from the Indiana University School of Medicine on Dec. 22 will perform a new procedure for the treatment of epilepsy, called vagal nerve stimulation. The procedure offers a treatment option only recently available to patients with epilepsy who do not respond to conventional treatment.

“This is a new approach to treating epilepsy,” said Jorge Asconape, M.D., associate professor of neurology. “Until recently, physicians had two ways to treat it, the traditional approach was drugs or conventional surgery. Surgery, in most cases, involves removal of the area of the brain that is causing the problem.”

Now patients who do not respond to treatment with medication or do not quality for conventional surgery because multiple areas of their brains are involved in the seizures may be candidates for the vagal nerve stimulation procedure.

During the 1 1/2- to 2-hour surgery, surgeons implant a generator with a programmable chip in the left chest wall of the patient. The generator, which is about two inches in diameter, is similar in appearance to a pacemaker.

A second incision is made on the left side of the patient’s neck where the vagus nerve is located. A lead with electrodes on it is wrapped around the nerve and about two weeks after the surgery, the generator is programmed to send electrical signals through the lead to the nerve.

Dr. Asconape explained that the vagus nerve on the left side of the neck controls the functioning of the abdominal organs, conveying signals to the brain. The vagus nerve on the right side controls the functioning of the heart. The stimulator is placed on the left side to eliminate the possibility of interfering with cardiac rhythms.

“The vagus nerve conveys lots of information to the brain in its process to regulate all of these activities,” Dr. Asconape said. “Discovery of the connection with epilepsy was more or less serendipitous.”

During the vagal nerve stimulation process, the generator stimulates the vagus nerve causing it to send signals every few minutes to the brain. When patients have seizures, normal brain activity is interrupted and is replaced by abnormal brain waves that are highly synchronized. Vagal nerve stimulation produces a “desynchronization” of the brain wave and, possibly by this mechanism, stops the seizures.

In case of an ongoing seizure, patients and/or their caregivers can activate the generator with a magnet causing it to send an instant signal to the brain which, in some cases, may abort the seizure.

Dr. Asconape cautioned that the vagal nerve stimulator is considered a palliative treatment because very few patients become seizure-free from the procedure. Some patients can experience a large reduction in the number of seizures.

Nearly 1 percent of the U.S. population has epilepsy and approximately 10 percent of those do not respond to conventional treatments. In Indiana, approximately 3,000 to 6,000 patients have refractory epilepsy and many of these may be candidates for vagal nerve stimulation.

Individuals interested in additional information on the vagal nerve stimulation procedure at IU School of Medicine may call 317-279-0406 or 1-800-210-7123.

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