Treatment of Epilepsy: Resective Surgery

Vagus nerve stimulation (VNS) is an adjunctive treatment for certain types of intractable epilepsy and treatment-resistant depression. VNS uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin. The tenth cranial nerve arises from the medulla and carries both afferent and efferent fibers. The afferent vagal fibers connect to the nucleus of the solitary tract, which, in turn, projects connections to other locations in the central nervous system. Little is understood about exactly how vagal nerve stimulation improves seizure control, but proposed mechanisms include alteration of norepinephrine release by projections of solitary tract to the locus coeruleus, elevated levels of inhibitory GABA related to vagal stimulation, and inhibition of aberrant cortical activity by reticular system activation.

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