VNSTherapy for Epilepsy

1 VNS Th er apyforEpilepsyThi s pam phletprovides generalinf orm ationfor the is not intended tocov er al l pos sibleuses, di rect ions,pre cautions,interactionsor adverse effectsinvolvi ng any productor devi ce. It is not medicaladviceand shouldnot bereli ed uponby consumers as l questionsaboutvagusnerve stimulation,or any therapyfor epi lepsy,shouldbe discussedwit h your treating der stan din g VagusNerveSti mu lat io n (V NS ) TherapyVNS Ther apy is a treatment approach th at ca n improveseizu re con tr ol, moodand qualityof life over may alsopro vi de an im provedsenseof controland independenceto peo -ple withdr ug resistantepil epsyand allo w patientsto leadmorenor mal live Ther apy was approvedby th e Foodand DrugAdministration (FD A)

2 In 1997as an add -on treatmentfor certainkind s of hard -to-controlepi add -on treatmentis onetha t is usedin addi tion to anothertypeof therapy usually,tre at mentwi th medicati Ju ly 2005 , the FDA also approved th is therapyas a treat -men t for chr onic or recurrenttreatment-resistantdep ressionforpat ie nts 18 year s of age or olderwhoexpe rien ce maj or depres-sive episodesand havenot had an ad eq ua te responseto four ormor e adequate anti e therapyincludesa pacemaker-like deviceaboutthe siz eof a half doll ar. It is placedin the chestan d neck, just un der theskin, involvin g two smallinci procedure, whichtakesabo ut an ho ur , is usually don e as standard outpatient surgeryund er gene ral ane sthesia. The deviceworks continuousl y bysend ing smal l el ectricalimpulses to the va gus ne rve in the se impulses thengo to the brainto hel p preventseiz ureswhe re ramshowshowthe implantedpulsegenerator ,lowerright, is linkedby electrodesto the left vagusnerveinthe enlargedsectionof the diagram(upperright)showshowthe endsof the flexiblesiliconeleadsarewoundaroundthe grammingthe DeviceIt is recommendedthat the deviceis tu rne d on du rin g thepat ie nt s checkup visi t, usually two we eks afterthe surg ors prog ram the devi ce to del iver pulse s of ele ctricalstimu lationautomati call y, 24 hoursa da y.

3 A typi cal stimulati on dos e is ab out 30 secondson and five min utesoff, but setti ngsmay vary ba sed on indi e devi ce continuesthecycle untilthe neurologistreprogramsit or unti l th e batteryrunsout usually in 8 will vary de pendingon howthedev ic e is g of fic e visi ts, the doctorchecksth e de vice to ma kesur e it is working properlyand that the trea tmentis no t makingthe patientuncomfortable. VN S therapy implantshavelow inci -den ce, if any, of side effectssuchas de pre ssion,dizz iness,con -fus io n, wei ght gai n, fatigue,insomnia,ra sh, facialha ir and lowene rgy . The mostcom monsi de effectsare te mporary ho arse -nes s/changes in voicetone,cough,tickli ng in the throatandshor tnessof breathwhi ch occuronly durin g stimulati metimespeopleworry that the de vice may be rejected bythe body.

4 Th e deviceis madeof titanium, a materialthat iswide ly us ed for pacemakers,and doe s not triggeran immuneres po nse. If it has to be rem oved,it is usua lly becauseit is noteff ec tive or becauseof infection fromth e surgery. Infectionrateswith the im pl ant are considerablylow, abo ut 1 of the most uni que aspectsof th is typ e of the ra py is therole that a specialmagnetplaysin the trea specialthin bl ock magnetis atta che d to a strapthat ca neit her be worn on the wri st li ke a watch , or cli ppedto a belt likea devicedeli vers sti mul ationautomatical ly , 24 hoursaday , and the magnetcan be usedto del iver is doneby the patientor a caregiver passi ng the magnetover the chestareawherethe deviceis im the ma gn et in this way whe n theyse nse aseizureis abo ut to some,th e extra stimulatio nst op s th e seizure, sh or tensit, makesit les s severe.

5 Orred uce s the timeit ta kes to rec ov er er peop lesay using the magnet has lit tle or no effe ct on th eir sei zu w wel l will it work?It s hard to knowin advancehowsom eon e wi th drugresis -tan t Epilepsy wil l respondto VNSTh erap ny patients defi ne successby th e red ucti on in the numberof se izurestheyexperienceand,som etim es, the reductioninhow longthei r dies show4 out of 5 patientswi ll exp eri encesomered uc tion in thei r seizuresand that 40 % of pa ti entshavelesstha n half the seizurestheywerehaving as a resultof VNSThe rapy . A uni que featureis that seizure controlsi gnificantlyimpr ovesov er ti me and tendsto maintain its effective ,man y patients experienceless severese izu res, shorterse iz ures,impr ovedrecoveryperiodsafterseizures, fewerclustersandfewe r visitsto the h the devi ce, most pati en ts exp eri ence a betterquali ty oflife regardless of the reductionin theirsei zure s.

6 Manypatientsrep or t impr ovement in alertness,mood,ve rbal skillsand memo-ry. In addition, 3 out of 4 pati entshavebe en abl e to decreasethe numberof theiranticonvulsantdrugsor dosages,potentiallyred uc ing side effectsassociatedwiththo se e soonerVN S Therapyis used,th e more likel y it is toimpr ove longtermsei zure controland qua li ty of li fe. It ha s beenshownto be most effectivewhen usedearl y; within tw o yearsofdia gnosis and afterfai lure of only 2-3 ad eq uate en whenpeoplerespondwell,imp rove ment usuallytakestime . It isn t like ly to happenimm ediately afterthe doctorimpla nts th e y go by beforethere sany change,fol lowedby a slowbut ste ad y ca use of thi s, pati entsare encouraged to committo VNSThe rapyfor a leasta 2 yo u or a familymemberare thinkingof startingVNST herapy,it may be helpfulto talk tooth er people whoare alreadylivingwith th e in g th e ma gnetOne of the most uni que aspectsof th is typ e of the ra py is therole that a specialmagnetplaysin the trea specialthin bl ock magnetis attached to a strapth at ca neit her be worn on the wri st li ke a wat ch , or cli ppedto a belt likea ho ugh thi s therapydeli vers stimulati on automatica lly , 24hou rs a day.

7 The magnetcan be usedto del iver extrastimulati is doneby the patientor a caregiver passi ng the magnetover the chestareawherethe deviceis im ple use the magnetin this way whe n the y sen se aseizu re is aboutto som e, th e extra stimulationstopsthe seizure,shortensit, makesit less se ve re, or reduces the timeit tak es to op le say usingthe mag -net has littl e or no effecton t ever yon e wi th an impl ant has a wa rn ing be fore a seiz urebeg in s. However, duri ng a sei zure,fami ly membersand care -giv ers can also be shown howto passth e magnetovertheimpla nt. Thi s ma y hel p to shortenor stopthe seiz ure s special VNST herapy Systemmagnetis worn on the wri ma gnetcan alsobe clippedto a belt , like a e magnetoffersmany patients with dru g re si stantepi le p-sy and the ir fam il ies or care gi vers an in crea sed senseof controltha t may also hel p im provequalityof li e magnetcan also be usedto gi ve peop le a shortbreakfro m the pro grammed sti mul holdingthe special magnetin pla ce over th e devi ce,some one wi th an im plantcan stopstim ula tion or turn off thepuls e generator for a sons for wantingto stopthe stim ul atio n may include.

8 Plansto sing or speakin public(to preve nt ch angesinvoic e tone du ri ng sti mulation) Eating(if people havea pre-existing co nditiontha tmak es sw al low ing di ffi cult) Duringexercise (if pati entsexpe rie nce shortnessofbr eat h uponexertion duringstim ul ati on pha se) Experiencingpainor otherunu sua l di scomfort duringthestimu lat ion o Uses VN S therapy ?VNS Ther apy is app rovedfor adults and adolescents ove r 12year s of age wit h partialonsetseizures- seiz uresthat begininone part of the brai is intendedfor people whosesei zu res do not respondtomed icationsand whoare eithernot good candidatesfor brainsur ge ry , don t want to havebrainsurgery or thosewhomay stil lexpe rienceseizuresafterbrai n rently , about40,000peoplehaverece ive d VNST herapywor ldwide.

9 W henI got the VNS Ther apy imp la nt,it changedmy stilltakeme di ci ne ,andI stillhaveseizures, but I canhon estlysaymy se izu res haveimp ro ve dandI am ableto functio n mu ch bet te r. 5Wh o ShouldNotUseVN S The rapyVNST herapycannotbe usedin patie nts aftera bil ateralorle ft cervicalvagotomy (rem ova l of the left or bothvag us nerves).Co stOnce the neurologistrecommendsVNSThe rapyas a possi-ble treatment,there sthe questionof how muchit costsandho w to pay for in sur ancecom panies,alo ng with Me dicarean d mostMe dicaidcarrie rs, coverthe costsof VNSThe rapy .Peop le whoqual ify for thi s treatment bu t do not haveinsur-an ce or oth er fundsto pay for the devicemay qu alifyfor specialassistancefr om Cyberonics,Inc., the man ufacturer of theim pla nt.

10 The com panyhas a rangeof su pp ort available to helppa tientsinterestedin etyFor a completelistingof safetycon cern s pleaseconsultwithyo ur doctoror vi sit the manufacturer swe eque nt ly Ask ed Questions1. Do smallele ctricalappliances,cellularphonesormet al detectors af fect VN S Ther apy?Accordingto the manufacturer,prop erl y ope ra ti ng microwaveovens,toasters,hai r dryers,and electri ca l app li ance s shouldnotaff ect the pulsegenerat or . Bas ed on te sti ng to date,cell ul arpho nes do not affectthe pulsegen era to r. Metaldetectorsat ai r-por ts and otherpl acessho ul d no t affe ct th e Whatare the hazards,if any , of otherkindsofmedi cal tre atmentor tests whensom eonehas aVNS Therapyimplant?Most rout ine pro -cedur es, suchashav ing a routineult rasoundor anx-ray, shouldno taff ect yourtherapy,but anyonewiththeimplantshouldalw aysbe sureto showtheirCyberonics, ntificationcardto al ldoc tors, dentists,nurses,phy sicalor spor ts ther apists,reh abilitationproviders,chi ro -pra ctors,or any healthprof essi ona lpro vidingtreatmentof any ki nd.