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Vagus Nerve Stimulator (VNS)

The vagus nerve stimulator (VNS) is a surgically implanted device that intermittently stimulates the left vagus nerve to decrease seizure frequency. It is a palliative, not curative, procedure that has been performed in adults and in some children with intractable complex partial seizures or generalized tonic seizures who were not candidates for definitive surgical cure. Why this works is not well understood.
Although the VNS has been placed in children younger than 3 years old [Zamponi: 2008], it is usually placed in older children. The VNS is generally well-tolerated and safe for children and adults. The median reduction of seizure frequency is about a third at 1 year and 40% by 18 months. Several months may go by before there is any change, followed by a slow but steady improvement in seizure frequency. In 1 study, 60-90% of children showed a reduction in seizure frequency. [Zamponi: 2008] [Fan: 2018]

Complications that occur with VNS use include failure of the device to work (3%), infections (3%), and stimulus-associated hoarseness and swallowing problems. [Smyth: 2003] Sleep-related breathing problems have also been described. [Hsieh: 2008]

Evaluation for and treatment with VNS for children is performed in epilepsy clinics. The VNS is reserved for children with intractable seizures. Frequent follow-up with pediatric neurology will be necessary after insertion of the VNS.

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Authors & Reviewers

Initial publication: September 2008; last update/revision: January 2019
Current Authors and Reviewers:
Authors: Lynne M. Kerr, MD, PhD

Page Bibliography

Fan HC, Hsu TR, Chang KP, Chen SJ, Tsai JD.
Vagus nerve stimulation for 6- to 12-year-old children with refractory epilepsy: Impact on seizure frequency and parenting stress index.
Epilepsy Behav. 2018;83:119-123. PubMed abstract

Hsieh T, Chen M, McAfee A, Kifle Y.
Sleep-related breathing disorder in children with vagal nerve stimulators.
Pediatr Neurol. 2008;38(2):99-103. PubMed abstract

Smyth MD, Tubbs RS, Bebin EM, Grabb PA, Blount JP.
Complications of chronic vagus nerve stimulation for epilepsy in children.
J Neurosurg. 2003;99(3):500-3. PubMed abstract

Zamponi N, Rychlicki F, Corpaci L, Cesaroni E, Trignani R.
Vagus nerve stimulation (VNS) is effective in treating catastrophic 1 epilepsy in very young children.
Neurosurg Rev. 2008;31(3):291-7. PubMed abstract