28. When Should Vagus Nerve Stimulation Be Considered, and What Can It Accomplish?

  1. John W. Miller MD, PhD Director, UW Regional Epilepsy Center, Professor of Neurology and Neurological Surgery2 and
  2. Howard P. Goodkin MD, PhD The Shure Professor of Neurology and Pediatrics, Director, Division of Pediatric Neurology3
  1. Pearce J. Korb and
  2. Sandra L. Helmers

Published Online: 10 JAN 2014

DOI: 10.1002/9781118456989.ch28



How to Cite

Korb, P. J. and Helmers, S. L. (2014) When Should Vagus Nerve Stimulation Be Considered, and What Can It Accomplish?, in Epilepsy (eds J. W. Miller and H. P. Goodkin), John Wiley & Sons, Oxford. doi: 10.1002/9781118456989.ch28

Editor Information

  1. 2

    University of Washington, Seattle, WA, USA

  2. 3

    Department of Neurology, University of Virginia, Charlottesville, VA, USA

Author Information

  1. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

Publication History

  1. Published Online: 10 JAN 2014
  2. Published Print: 14 FEB 2014

ISBN Information

Print ISBN: 9781118456941

Online ISBN: 9781118456989



  • Vagus nerve stimulation;
  • Epilepsy;
  • Refractory epilepsy;
  • Treatment;
  • management;
  • Neuromodulation;
  • Neurostimulation;
  • Neurosurgery;
  • Vagus nerve;
  • Adjunctive therapy


Vagus nerve stimulation (VNS) is an adjunctive treatment for refractory epilepsy using an implantable neuromodulatory device. The device is approved for refractory focal epilepsy in patients 12 years or older but also has been shown to be effective in generalized epilepsies and pediatric populations. It consists of a pulse generator inserted in the superficial left chest with electrodes attached to the left vagus nerve. The stimulus is delivered automatically at regular intervals and can also be triggered with a voluntary magnet swipe. It is proposed, but not proven, that the mild electrical impulses disrupt activity of thalamocortical connections and prevent seizure propagation. The stimulation settings can be changed in order to increase effectiveness or reduce side effects. Most of the common side effects can be attenuated or eliminated with setting adjustment.