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Controversies in Neurology
February 1998

Vagus Nerve Stimulation for Treatment of Seizures?Yes

Author Affiliations

From the Department of Clinical Neuroscience, Sahlgren University Hospital, Göteborg, Sweden.

 

VLADIMIRHACHINSKIMD, FRCPC, DSCMED

Arch Neurol. 1998;55(2):231-232. doi:10.1001/archneur.55.2.231

VAGUS NERVE stimulation (VNS) is a new treatment available for patients with refractory epilepsy. The first implant was performed in 1988, and since then more than 900 patients have received this therapy. There has been skepticism among epileptologists concerning VNS. Many have questioned the efficacy of this treatment, referring frequently to the disappointing results of early cerebellar and thalamus stimulation attempts. Vagus nerve stimulation has erroneously been compared with epilepsy resective surgery, and many have the opinion that VNS proponents promote using VNS rather than traditional surgery when it is indicated. Some neurosurgeons have insinuated that clinicians who use VNS are depriving their patients of the possibility of resective surgery and have not even bothered to evaluate them properly. Because of these misconceptions and heated debates, I want to make clear the distinction between resective surgery, which is a successful and superior method of treating selected patients who are deemed appropriate candidates, and VNS, which is best compared with the efficacy and adverse effects of the new antiepileptic drugs (AEDs). All patients entering into VNS protocols are usually extensively evaluated for epilepsy surgery and are not implanted with the VNS device haphazardly. Unfortunately, the majority of patients with refractory cases are not epilepsy surgery candidates, so the development of other techniques, such as new drugs and VNS, are, of course, necessary.

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