Vagus nerve stimulation has been used in the treatment of drug-resistant epilepsy since the 1990s. Vagus nerve stimulator eliminates seizures or reduces their frequency and can be a last resort for people in whom anti-epileptic drugs are not effective. How does a vagus nerve stimulator work? What does the implantation procedure look like? Is it reimbursed by the National He alth Fund?

Vagus nerve stimulator(VNS - Vagus Nerve Stimulator) is a form of adjunctive therapy in patients with refractory epilepsy. Patients who have undergone long-term, documented pharmacological treatment and have failed, are eligible for the vagus nerve stimulator implantation procedure. The procedure is especially recommended for those patients whose seizures are preceded by the heralds (the so-called aura) or who have seizures without disturbance of consciousness.

Vagus Nerve Stimulator - How Does It Work?

The stimulator sends impulses of electricity to the brain via the vagus nerve (i.e. the nerve that runs from the brain through the neck to the main organs - heart, lungs and stomach - located in the upper part of the , overly excitable neurons), prevent bioelectric discharges in the brain, and thus - epilepsy.

These pulses are sent at regular intervals (e.g. every 5 minutes for 30 seconds), and the current intensity is determined for each patient individually using the computer.

Vagus nerve stimulator - what is the procedure?

The procedure of implantation of the vagus nerve stimulator is performed under general anesthesia. The doctor makes an incision on the left side of the chest at the level of the armpits. Then a kind of pocket is created, into which a stimulator (pulse generator) is inserted, i.e. a disc with a diameter of approx. 5 cm and weight 30 g with a titanium coating.

The doctor then makes an incision in the neck to separate the vagus nerve and install electrodes over it. They are attached to small plastic worms that become wrapped around the vagus nerve. The surgeon then passes a wire under the skin that connects the electrodes to the pacemaker.

The last step is to program the pacemaker to generate electrical impulses of a certain strength at regular intervals. It takes care of itgroup of neurologists. When the settings are correct, the notches are stitched.

The patient stays in the hospital for several days after the operation.

How to help a patient with an epilepsy attack?

Important

Vagus nerve stimulator is reimbursed by the NHF

The vagus nerve stimulator was introduced to the catalog of procedures reimbursed by the National He alth Fund in 2013, in accordance with the Ordinance of the Minister of He alth of November 22, 2013 on guaranteed benefits in the field of hospital treatment.

On October 20, 2014, the Minister of He alth signed an ordinance amending the ordinance on guaranteed benefits in the field of hospital treatment. It shows that "patients with frequent seizures in whom epilepsy is dominated by partial seizures with or without secondary generalization or generalized seizures resistant to antiepileptic drugs, including performed diagnosis of refractory epilepsy and brain MRI, are eligible for the implantation of the vagus nerve stimulator. ".

As informed by the Ministry of He alth, the regulations enter into force on the day of their announcement, January 1, 2015, April 1, 2015, and July 1, 2016.

Vagus nerve stimulator - what after surgery?

Each patient receives a magnet which causes an immediate impulse when placed on the stimulator under the skin. This is a form of protection against a seizure that may begin when the pacemaker is resting. The magnet makes it possible to start it in no time. Patients usually wear small magnets embedded in, for example, a bracelet.

Periodic reprogramming of the vagus nerve stimulator is required. The clinician will change the pacing settings using a computer, configuration software, and programming remote. The clinician can reduce or increase the amperage and extend or shorten the device's inactivity time.

Important
  • Stympator doesn't always work right away. Sometimes the body takes up to six months to get used to it.
  • Stympator does not guarantee improvement of the patient's he alth - not all patients experience a reduction in seizure frequency.
  • Implantation of a pacemaker does not always mean discontinuation of antiepileptic drugs, but it can sometimes significantly reduce their doses.
  • At first, you may experience hoarseness, coughing, difficulty swallowing, hiccups, and a feeling of numbness in the neck when the pacemaker is turned on. These problems should disappear a few weeks after the device has been implanted.
  • Stympator can be removed at any time, if the patient does not like its presence.

Category:

Neurology