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Treatment of epilepsy by stimulation of the vagus nerve

Neurology Service and Department of Neurology and Brain Institute (Drs. Uthman, Wilder, and Hammond), Veterans Administration Medical Center, and the University of Florida College of Medicine, Gainesville, FL; the Department of Neurology (Drs. Penry and Dean), Bowman Gray School of Medicine, Winston-Salem, NC; the Neurology Service (Dr. Ramsay), Veterans Administration Medical Center, Miami, FL; the Neuroscience Institute of Santa Fe (Dr. Reid), Gainesville, FL; and Cyberonics, Inc (W.B. Tarver and Dr. Wernicke), Houston, TX.

We treated 14 patients with medically refractory partial seizures by stimulation of the vagus nerve in two single-blind pilot studies. Patients received stimulation through an implantable, programmable Neurocybernetic Prosthesis, consisting of a pulse generator and a lead-electrode assembly. The mean reduction in seizure frequency after 14 to 35 months of vagal stimulation was 46.6%. Of the 14 patients, five (35.7%) had a 50% or greater reduction in seizure frequency. Two patients, one of whom had had 10 to 100 seizures per day before stimulation, have been seizure-free for over 1 year. Adverse events were primarily limited to initial hoarseness and a tingling sensation at the electrode site in the neck when the device was activated. Most patients tolerated the device and stimulation well. There were no permanent adverse events. Some cases of medically refractory partial seizures are improved by vagal stimulation.

Address correspondence and reprint requests to Dr. Basim M. Uthman, Department of Veterans Affairs Medical Center, Neurology Service (127), Gainesville, FL 32608-1197.

Supported by the Medical Research Service of the Department of Veterans Affairs and the Epilepsy Research Foundation of Florida.

Received September 18, 1992. Accepted for publication in final form November 10, 1992.

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