17. Vagal Nerve Stimulation
18. Epilepsy Surgery

17. Vagal Nerve Stimulation

In vagal nerve stimulation, a coil is wrapped around the vagus nerve and is stimulated electrically with a pacemaker-like device that is placed under the skin, below the clavicle. The repetitive stimulation of the vagal nerve delivers an impulse to the brain that is protective against seizures. The implementation of the device requires a minor surgical procedure.

The device becomes activated about 2 weeks following the implementation and the neurologist controls the amount of stimulation delivered. Other than seizure protection, vagal nerve stimulation is reported to improve memory, decrease side effects, as these are being weaned off. Recently, some reports indicate beneficial effects in mood disorders.

18. Epilepsy Surgery

Most commonly consists of resectioning an epileptogenic (seizure producing) brain region. Surgery is usually the last resort for patients who fail to respond to other anti-epileptic managements. There are several surgical options depending on the type and location of the seizure focus.

The most successful epilepsy surgery is for the treatment of partial seizures when a clear lesion can be detected, such as in the case of mesial temporal sclerosis, or the atrophy of the gray matter in a very specific area at the tip of the temporal lobe. When the lesion is on the right side, chances are better that language will not be affected by surgery. Prior to the surgery, however, close EEG monitoring is required in order to localize the seizure focus precisely and to prevent the extraction of functional brain regions. In some situations an EEG grid is implanted close to the brain in order to obtain more accurate monitoring.

The results of surgery are generally good, making it a valid option for the appropriate candidate. Families, however, should be aware of some potential surgical complications, the possibility (depending on the seizure type) that seizures will continue after the surgery, and that medication may be needed in combination with surgery to obtain the best seizure control.