Epilepsy Talk

TNS vs. VNS – NO SURGERY! | June 18, 2020

The first Vagus Nerve Stimulator (VNS) was implanted in 1988, as a therapeutic option for medically intractable epilepsy, when elective epilepsy surgery was not appropriate.

As the number of implanted vagus nerve stimulators grows, so does the need to remove or revise the devices.

Which is a little tricky, because of the spiral stimulating electrodes, wrapped around the nerve.

Especially if the VNS treatment has proven ineffective.

And of course, what goes in, must come out.

Anyway you look at it, there’s more surgery involved.

The up side to having a VNS is better seizure control.

The down side is discomfort, headaches, temporary hoarseness and shortness of breath.

Meanwhile, the success rate is iffy. Studies have shown that:

About 1/3 of patients have had the number of their seizures reduced by half or more; less than 5% of patients become seizure free…

About 1/3 have shown benefit but have had their seizure frequency reduced by less than half…

About 1/3 have had no worthwhile benefit.

On the other hand, Trigeminal Nerve Stimulation is a nerve stimulation therapy that requires NO SURGERY and reduces seizures among those who are drug resistant by about 40 percent.

The TNS system has two components: a hand-held pulse generator — which is about the size of a cell phone — that creates the electrical signal and a disposable custom electrical patch — much like a gel pad — that delivers the signal to its target, the trigeminal nerve.

Because it is a large sensory nerve, the trigeminal offers a high-bandwidth pathway for electrical signals to enter the brain.

All you have to do is apply the gel-like electric pads to your forehead and connect them to the pulse generator.

The only sensation you may feel is a mild “tingling” sensation.

“The device is appealing because it doesn’t require surgery, doesn’t have side effects and is very easy to use, says Jennifer Rees, 49, who lives in the Los Angeles area and has been using the nerve stimulator for six years as part of a test group.

She wears her patches while sleeping, putting one gel pad above each eyebrow. And…

“For me it’s extremely effective.” Rees says that before using the stimulator, she was having up to eight seizures a month.

The device alone reduced that to about one seizure a year.

And she hasn’t had any seizures since she added low doses of a medication more than 18 months ago.

Because, it could offer an alternative or enhancement to treatment with drugs,says Christopher DeGiorgio, the neurologist at UCLA who invented the new approach.

DeGiorgio said: “I’m encouraged to see that our non-invasive and safe approach to neuromodulation compares favorably to pharmaceutical and surgically implanted  device therapies of drug-resistant epilepsy.”

And one more piece of good news: In some studies on patients with depression and post traumatic stress disorder, the patch resulted in a 70 per cent reduction in symptoms!

 

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Resources:

https://www.frontiersin.org/10.3389/conf.fnagi.2016.03.00032/event_abstract

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874575/

http://www.epilepsy.org.uk/info/treatment/vns-vagus-nerve-stimulation

http://www.npr.org/2011/07/27/138619259/new-device-reduces-seizures-no-surgery-required?ft=1&f=100

http://www.news-medical.net/news/20120914/Trigeminal-Nerve-Stimulation-an-interview-with-Dr-Leon-Ekchian-President-and-CEO-of-NeuroSigma.aspx

 


10 Comments »

  1. I probably mis-remember this, but it seems there was a hand-held vagus nerve stimulator that was applied against the side of the neck. Not available in the U.S..

    Liked by 2 people

    Comment by HoDo — June 18, 2020 @ 10:14 AM

    • Could it be the Responsive Nerve Stimulator that you’re thinking of?

      The RNS is consists of a miniaturized, implanted computer (that’s flat and about the size of a half-dollar). It can detect seizures from electrodes implanted into or on the surface of the brain and then delivers an electrical pulse to stop them.

      With a programmer, a laptop computer with specially designed software — plus a wand and special interface — direct communication is made with the implanted RNS neurostimulator.

      Patients wave that wand over the device to download data recorded before and after stimulation, so that physicians can monitor how well these parameters are working and adjust them accordingly.

      The RNS is now available in most Level 4 Comprehensive Epilepsy Centers, throughout the U.S.

      Like

      Comment by Phylis Feiner Johnson — June 18, 2020 @ 11:28 AM

      • Have to say, I don’t recall. There was a photo of some guy holding a box-like device against his neck. No implants. But that was a while back and I had no reason to pay particular attention. It would be nice if true.

        Liked by 1 person

        Comment by HoDo — June 18, 2020 @ 11:31 AM

      • Ok. I’m stumped. 🙂

        Like

        Comment by Phylis Feiner Johnson — June 18, 2020 @ 11:50 AM

  2. Goodmorning Phylis and HoDo 😊. You know I TRIED (for the LIFE OF ME) to ask IF I COULD TRY THAT and that (NOW MY EX) NEUROLOGIST WOULDN’T EVEN LET ME FINISH THE SENTENCE BEFORE TELLING ME “NO YOUR NOT A CANDIDATE!!”. Honestly I kind of chuckled and BIT MY LIP!! Because somebody already said what I wanted to but never did!! Secretly I was TRYING TO BE THE RESPECTFUL ADULT AND PATIENT!! Plus I didn’t want to be labelled by my OLD NEUROLOGIST AS A “UNHELPFUL OR REBELLIOUS PATIENT!!” (Between us) 😊

    Liked by 1 person

    Comment by Kathy S.B — June 18, 2020 @ 10:38 AM

  3. I had my VNS removed in February. I had it for a year and It never caused any improvements. If anything it made things worse for me. When I went out dancing I would run to the bathroom gaging when it fired. I felt like I couldn’t breath and it caused a lot of anxiety. I was having more seizures; simple partial, complex partial, and grand mal. And having the device in my chest was uncomfortable. I recently started taking Epidiolex, CBD oil, and I’m 13 days seizure free. That’s pretty incredible for me!

    Liked by 1 person

    Comment by Kelly Falk — June 18, 2020 @ 1:29 PM

    • CONGRATULATIONS on being seizure free for 13 days. Let’s hope that’s the beginning of a new winning streak!

      Like

      Comment by Phylis Feiner Johnson — June 18, 2020 @ 1:34 PM

  4. I am VERY LUCKY in the sense that I am part of the 1/3 of patients and the less than 5% of patients becoming 3, almost 4 years seizure free (knock on wood) with the VNS. I think I was around 16 years old when my neurologist discussed this as an option since all of the different medications I was taking did not help me control my seizures. My neurologist said that I could be a candidate for the VNS surgery, but he was very reluctant about me opting to have the VNS surgery because he knew and explained the statistics to me and my mom that there is a chance that the VNS may not help me. After a year of discussing the pros and cons with my neurologist and my family, we decided to have the VNS surgery when I was 17 years old. While I do still have to deal with the side effects of shortness of breath and having a hoarseness sound to my voice, those side effects have gotten better over the past 3 years. I am now 21 years old, and I am now in my senior year of college studying communication disorders with the concentration in pediatrics and hopefully will be able to specialize in neuroscience and voice disorders in graduate school; and I have not had a seizure since August 4, 2016 (knock on wood). With that being said, I feel like I need to emphasize that I probably would not be doing this good if it wasn’t for the amazing neurology team that has helped me improve my quality of life for the past 8 years. I am a neurology patient at Le Bonheur Children’s Hospital where they hold the rank of the #1 neurology program for a children’s hospital in the country. (I am allowed to see my current neurologist until I am 23 years old, so please don’t judge me for still seeing a pediatric neurologist lol.) I have been VERY PRIVILEGED to have access to amazing doctors and surgeons who are constantly checking to make sure that my VNS is working for me in collaboration with the anti-seizure medications I take. The VNS works differently and has different results for everybody who has it because everyone’s Epilepsy is different. For me, I have been lucky in the sense that I fall into the positive statistical category.

    Liked by 1 person

    Comment by Kelcie Wehrum — July 8, 2020 @ 1:48 PM

    • Thank you for telling your story. Every good wish for your career plans in a field where real expertise is needed.

      Liked by 1 person

      Comment by HoDo — July 8, 2020 @ 3:22 PM

    • What a great response. What a great story.

      Give yourself some credit, though Kelcie. You did need to have courage to go through with the surgery.

      Despite the most dedicated neurology team, you were PART of the team. And you made it work.

      I expect to hear that you’re seizure-free this August 4th and many more to come.

      Congratulations! Best of luck in your studies.

      Like

      Comment by Phylis Feiner Johnson — July 8, 2020 @ 3:27 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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