when a patient’s vagus nerve is stimulated, what does the nurse expect to observe?

What is VNS Therapy^®?

VNS Therapy^® (also chosen vagus nerve stimulation) has been approved by the U.Due south. Food and Drug Administration (FDA) every bit an addition therapy for adults and children four years and older. It is approved to treat focal or fractional seizures that practise non respond to seizure medications. This is called drug-resistant epilepsy or refractory epilepsy.

• Vagus nervus stimulation (VNS) may foreclose or lessen seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nervus.
• The therapy consists of a device that is implanted under the peel in the left chest expanse. An electrode or wire is attached to the generator device and placed nether the pare. The wire is attached or wound around the vagus nerve in the cervix.
• The device is programmed in the outpatient clinic to deliver pulses or stimulation at regular intervals. A person does not need to practise anything for this device to work.
• A person with a VNS device is usually not aware of the stimulation while information technology is working.
• If a person is aware of when a seizure happens, they can swipe a magnet over the generator in the left chest area to ship an actress burst of stimulation to the brain. For some people this may help stop seizures.

Factsheet

Download this factsheet to learn about VNS, how it works, and who can employ it.

How does it work?

Vagus nervus stimulation (VNS) is a type of neuromodulation. Information technology is designed to change how brain cells work past giving electrical stimulation to certain areas involved in seizures.

The vagus nerve is part of the autonomic nervous system, which controls functions of the body that are non under voluntary control (such as heart rate and animate). The vagus nerve sends information from the encephalon to other areas of the body. It also carries information from the trunk to the brain.

• We don't know exactly how VNS works. Research has shown that VNS may help command seizures by:
  • Increasing blood flow in key brain areas
  • Raising levels of some encephalon substances (called neurotransmitters) important to command seizures
  • Irresolute EEG (electroencephalogram) patterns during a seizure
• 8 out of x people with epilepsy may have an increase in their heart rate before a seizure.
  • In the newer VNS models (AspireSR^® and SenTiva^TM), a fast increase in middle rate tin be picked up. This triggers an actress flare-up of stimulation to help cease these seizures.
  • These models may be especially helpful for people who are not aware of when seizures happen, if seizures are not witnessed, or if seizures occur at night.

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How helpful is vagus nerve stimulation?

This therapy does not cure epilepsy. Information technology's designed to aid control seizures past lessening the number and severity of seizures.

• Initially, people with VNS had an average decrease in seizures past 28% in the first 3 months.
• A review of 65 people who were had VNS for 10 years or more, showed improvements in seizure control over time. Seizures decreased by 36% afterward 6 months, 58% after iv years, and 75% by 10 years subsequently the VNS was placed.
• Other ways VNS may help people were reported in a report of 112 adults with focal epilepsy that did not respond to medicines. People were placed in two groups: 1) VNS therapy and best medical practice, or ii) No VNS but received best medical exercise. Information was nerveless over a one-yr period. Results of this study showed:
  • Recovery time after a seizure may be shorter for some people.
  • viii of 10 people reported an improved quality of life.
  • About 6 of 10 reported less worry about seizures and improved alertness.
  • Half the people reported that their seizures were less severe.

When is vagus nerve stimulation used?

VNS is used for people with refractory or drug-resistant epilepsy. This means seizures are non controlled after trying at least 2 appropriate seizure medications.

• It's an add-on handling, which means it is used in addition to seizure medicines. For some people, when VNS works well, the dose or use of a seizure medicine may be decreased.
• VNS is ordinarily used if a person is not able to have epilepsy surgery or if surgery does not work.
• Sometimes a person may be offered VNS if other reasons make surgery not possible.

How do I know if I am a candidate for vagus nerve stimulation?

When considering VNS, ideally a person is first seen at a comprehensive epilepsy heart to brand sure that all options have been explored and that the procedure is right for them.

Here are a few questions that need to be asked.

What type of seizures practise you take?

• VNS will non help seizures that are not epileptic and non associated with electrical activity in the brain.
• It's primarily indicated for focal seizures, but people with some types of generalized seizures, including Lennox Gastaut Syndrome, have improved too.

Is the epilepsy truly drug-resistant and uncontrolled?

• It's important to see if other factors may be affecting seizures, and to treat those things first. For example, if a person is having problem taking medications regularly or has other lifestyle factors affecting seizures, counseling and educational activity about trigger management would exist needed first.
• An epilepsy specialist would review the types of medicines that yous have tried and make sure that y'all have tried the right drugs for the right blazon of seizures. And tried them for a long enough menstruum of time.

Are there other health bug that could exist affected past vagus nervus stimulation?

• People with significant asthma or other breathing bug, sleep apnea, or some heart problems may exist brash against using vagus nerve stimulation. Sometimes, other medical problems similar these could go worse with VNS.
• Anyone considering VNS (or any type of device) should cheque starting time with their master care physician to make sure this is right for them.
• People with merely i vagus nerve would not be good candidates for VNS.
• People who take had aberrant centre rhythms (arrhythmias) or a low heart charge per unit (bradycardia) should not use the autostimulation settings in the newer VNS models.

Can you lot go to the infirmary or clinic for visits to program and follow up on the device?

• Piece of work with your epilepsy team ahead of time to know how oft visits volition exist needed and how long they volition be.
• Accept a family fellow member or friend go with you to appointments, at least in the first. Once you are used to the therapy, you lot can usually go alone, but make certain you are safe to travel lonely.

Do you have support from family unit and friends? Do yous experience emotionally set to have this procedure?

• Some people may exist bothered initially by having a device put in their trunk, but they go used to information technology.
• The stimulation can also be adjusted and then well-nigh people will not feel information technology.

Are their unlike types or models of vagus nerve stimulation?

Over the years, engineering science has allowed new features to be added. There are now iii groups of devices.

Standard Models

These are the primeval devices. These have the basic programming features.

• A variety of settings tin exist adjusted. Usually stimulation is given for 30 seconds every five minutes. Some people practise ameliorate with different on and off settings.
• A magnet tin be used to trigger additional stimulation during a seizure.

AspireSR^® Model

This model was the first one to automatically give stimulation when periods of increased heart charge per unit are detected.

• Studies of this model showed that people who had heart rate increases with seizures could become more help with this autostimulation feature.
• The stimulation volition also occur at pre-programmed settings throughout the day and dark.
• A magnet can still be used for extra stimulation at the time of a seizure.

SenTiva^TM Model

This is the newest model of vagus nerve stimulation.

• Programmed stimulation can however be done, but at present the amount of stimulation can be adjusted at different times of the day. (For instance, day and night can have different settings.)
• Autostimulation can exist given when the device detects a period of fast heartbeat.
• A magnet can all the same exist used when a person has a seizure.
• Programming tin can be tailored to each person. For example, the programmer tin set up stimulation settings to change without coming to the hospital for each visit.
• The device can exist set to detect if a person is lying flat later on a seizure.

Safe Tips for VNS Magnet Apply

Annihilation that could exist affected past strong magnetic fields could be damaged by the VNS magnet if information technology is kept too close to it. Keep the VNS magnet at least 10 inches from these items, for case, bank cards, credit cards, watches, computer discs or difficult drives, televisions, or other items that may be affected past magnets.

A few safety tips include:

• Keep your magnet in a different pocket or on your belt buckle, abroad from your wallet.
• Create a metal lining for your wallet.
• If you use a calculator frequently, don't wear the magnet on your wrist – it may go too close to the computer. Wear information technology on your belt buckle or put it on the floor when y'all are working at the computer.
• Don't put magnets on top of a television receiver, stereo, or other electronic device.
• Don't enter rooms or places that have strong electronic or magnetic fields or that have warnings for people with pacemakers or other implanted devices.
• Ask your doctor or nurse to write a letter to use while traveling that explains the VNS device and magnets. Wands used during security checks could touch the VNS device or the magnet could trigger a security alert.

Using the VNS Magnet to Stop Seizures

The magnet can exist used anytime during a seizure, but it is most likely to piece of work when it is used towards the beginning of a seizure. The magnet can be used by the person with seizures or by some other person. Utilize the magnet if...

• You experience a warning or sense that a seizure may be coming.
• At the start of a seizure.
• When someone notices that yous are having seizure activity or someday during a seizure.

Using the VNS Magnet to Turn Off Stimulation

The VNS magnet tin also exist used to temporarily plow off stimulation. People can do this for different reasons. For example, people who accept occasional hoarseness every bit a side result of the VNS may want to stop the stimulation when they are singing or speaking in public. If a awareness of breathlessness occurs during stimulation, you may desire to temporarily plough it off during intense exercise. Those with swallowing troubles may desire to stop stimulation while eating or swallowing pills.

Talk to your doctor or nurse nearly when to turn off stimulation temporarily, for instance:

• If stimulation interferes with certain activities.
• If stimulation becomes uncomfortable or painful.

Resources

Detect an epilepsy specialist to aid you explore this, and other, treatment options.

The VNS Therapy^® implant devices are built by LivaNova (formerly Cyberonics, Inc.). Boosted information for patients and physicians is bachelor on their website (www.livanova.cyberonics.com).

Images on this folio included with permission from LivaNova.

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Source: https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns

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