What is Vagus Nerve Stimulation?
Vagus nerve stimulation is a procedure through which the surgeon stimulates the vagus nerves. It can be stimulated either electrically or manually. It is also known as VNS therapy. It is a USFDA approved method that can be done on children aged four and above. This method stimulates the vagus nerves with electric impulses by using a device. USFDA has approved an implantable Vagus nerve stimulator to treat epilepsy and depression. There is one vagus nerve present on either side of the body. It travels from the brainstem through the neck, chest, and abdominal region.
Who Needs Vagus Nerve Stimulation?
- For patients in which the episodes of seizures do not reduce with the medicines, the option of vagus nerve stimulation is the best choice to control the seizures.
- Vagus nerve stimulation is also used in stroke rehabilitation.
- According to FDA, vagus nerve stimulation can be used to treat patients who have:-
- Treatment-resistant depression.
- There was no improvement in the epileptic condition even after four or more medicine and electroconvulsive therapies.
What May Happen if Vagus Nerve Stimulation is Delayed?
If the vagus nerve stimulation is delayed, then the functions for which the vagus nerve is responsible may not work correctly. Some of the tasks for which the vagus nerve is responsible are:-
- Providing senses from the external part of the ear and certain throat parts.
- Providing sensation information for the lungs, larynx, heart and trachea.
- It also plays a small role in sensing taste.
- It stimulates the muscles of the heart and helps in reducing the heart rate.
If the nerve stimulation is delayed in medical conditions like epilepsy and depression, then the symptoms of the conditions may get worse with increasing time.
How is Vagus Nerve Stimulation Done?
- First, the patient will be asked to lay on the operation table.
- An anesthesiologist will inject a dose of general anaesthesia into the patient, and the patient will fall asleep (unconsciousness).
- This whole procedure generally takes about 45 to 55 minutes to complete.
- It is performed on an outpatient basis.
- Two small incisions are made. One is on the upper left side of the chest, where the device is to be implanted.
- Another cut is made horizontally on the left side of the lower neck. This cut is made along the crease of the skin. It is the cut in which a thin, flexible wire is inserted to connect the vagus nerve and the device implanted.
- After this, the implant is sewed in place using sutures, and the skin is closed.
- Cuts are sutured and bandaged, and the patient is shifted to the recovery room for further monitoring of the vitals.
- After implantation, it is programmed using a computer to generate an electrical pulse at a regular interval.
What To Expect Before Vagus Nerve Stimulation Surgery?
- Before starting the surgery, the doctor will do a physical examination of the patient.
- The doctor will go through the brief medical history of the patient to check the presence of any comorbidity.
- The surgeon may also advise some blood tests. These tests are done to ensure the good health of the patient and to check if that can cause any obstruction in surgery.
- The doctor may also ask you to take antibiotics even before the surgery.
- You will be asked to not eat anything after midnight on the day of the surgery. If the doctor prescribes any medicines, you can take them with a small sip of water.
- The doctor may also discuss the type of anaesthesia and its effect and side effects.
What to Expect On the Day of Vagus Nerve Stimulation?
- Before leaving home, you may take a bath. Hygiene is the most crucial factor in preventing unwanted contamination.
- It is beneficial to reach the hospital 2 to 3 hours before the allotted time.
- You may need to fill out a consent form.
- The staff will ask you to change into a hospital gown.
- An ID bracelet would be tied to your wrist to confirm the patient for surgery.
- The nurse will monitor all the vital signs like heart rate, blood pressure, breathing rate and pulse.
- After this, an IV line will be inserted in your arms, and then you will be wheeled to the operation theatre.
What to Expect During Vagus Nerve Stimulation Surgery?
- The whole procedure of the vagus nerve stimulation is done under the effect of general anaesthesia. Therefore, the patient does not experience pain or sensations during the whole procedure.
- All the vitals of the patients, like heart rate, breathing rate, pulse and blood pressure, is continuously monitored during the surgery.
- The nurse will insert a tube through the mouth to facilitate breathing during the surgery.
- The needed medicines like antibiotics and other nutritional supplements are given through the intravenous line injected into the arm.
What to Expect After Vagus Nerve Stimulation Surgery?
- After the surgery, you will wake up in the recovery room.
- All the vitals like blood pressure, oxygen saturation level, and heartbeat are continuously recorded until you wake up.
- Generally, the patient is allowed to go home on the same day of the surgery, but the stay at the hospital can be overnight in some cases.
- There will be some soreness around the incision for 24 hours after the surgery.
- You can expect dressing over the incision for a few days after the surgery.
First Follow Up Appointment
- Generally, the recovery after the vagus nerve stimulation surgery is very fast. However, the patient may feel much better after a few days of the surgery.
- The doctor may call the patient for the first to follow up two weeks after the surgery. The doctor may activate the implanted vagus nerve stimulator during this follow-up.
- The doctor will program it to deliver the nerve impulse to the vagus nerve. The device may be programmed to provide the impulse at a fixed interval.
- The nerve impulse generated by the device is low initially but can be increased with time depending upon the severity of the person.
When to Call a Doctor?
Do not hesitate or delay in calling your doctor if you are experiencing any of the following symptoms.
- Redness at the site of infection that is going away with time
- If the incision feels sore to the touch
- A foul smell from the location of the cut.
- Having fevers and chills even after several days of the surgery
- Drainage of pus from the incision wound
- Worsening of health condition
- If you have started feeling difficulty in swallowing, breathing, and any changes in your heart rate