Background

Vagus nerve stimulation (VNS) is an established treatment for epilepsy where medications have been unable to control seizures. It is particularly useful for people with epilepsy that cannot be treated by surgery to remove part of the brain. However, traditionally VNS is started slowly to avoid side-effects, reaching the treatment dose after 6 months. This means that it has not usually be thought to be a treatment option that can improve someone’s quality of life within weeks.

Research

We treated a consenting young woman who had many painful seizures per day with VNS because many medications had not worked and because identification of the region of the brain causing the seizures was not straightforward, making the route to surgical treatment complicated. What was novel was that under close monitoring, we increased the dose more quickly than ever previously reported in an awake person (4 times quicker than traditional VNS). She found the treatment tolerable and helpful, with the number of seizures occurring per day reducing by at least half and the individual seizures becoming less painful.

Potential impact

This study shows that VNS can be started safely and effectively, yet much quicker than previously known, with the potential to benefit people with epilepsy that is not responding to medication within a few weeks rather than months. Given that this is our experience with a single person over a few months, further studies involving more people and longer follow up will be needed to see how often and permanently people’s seizures might respond to super-rapid VNS treatment but it may become a option for people with dangerous or distressing seizures that are frequent and not controlled by medication.