Vagus nerve stimulation involves the use of an implantable device that delivers electrical pulses to your brain. It’s important to consider all the steps involved with this procedure so you can discuss them with a doctor before surgery.

The vagus nerve is one of the main cranial nerves in your brain. It’s also one part of the autonomous nervous system (ANS), which regulates functions in your body that operate involuntarily. Examples include your heart rate, blood pressure, and other essential functions.

If a doctor recommends vagus nerve stimulation (VNS), they believe the surgery may help your brain receive signals more effectively to manage certain conditions. Currently, VNS implants are approved for limited uses, though the ongoing research shows promise.

Before electing to have this procedure, consider talking with your doctor about all the benefits, risks, and steps involved with VNS.

VNS is a surgical procedure involving the implantation of a device in the chest wall. Also called VNS therapy, the treatment is designed to send signals to your brain via the vagus nerve.

The device itself consists of a small, round piece of metal measuring smaller than an inch and a half wide and a flexible wire to connect it to the vagus nerve. It’s similar to that of a pacemaker for your heart, and you won’t be able to feel the pulses as they occur.

VNS is usually performed by a neurosurgeon in an outpatient facility.

Currently, VNS implants are only recommended for certain people with drug-resistant (intractable) epilepsy or for those with treatment-resistant depression. The procedure may help send signals to help with seizures and depression symptoms, respectively.

As one 2021 clinical review notes, there may be several future uses for VNS outside of these conditions. Among the most promising include stroke, traumatic brain injury, and Parkinson’s disease, but the FDA has not yet approved VNS for these uses yet.

Other possible future uses for VNS include certain chronic inflammatory and autoimmune diseases, such as diabetes, inflammatory bowel disease (IBD), and rheumatoid arthritis.

VNS for epilepsy

VNS was first approved by the FDA for epilepsy in 1997 as a treatment for seizures in people who do not respond to at least two anti-epileptic medications. It’s thought to help by reducing the number of seizures, as well as their severity and length while improving recovery and overall quality of life.

However, instead of replacing these medications, VNS is considered a complementary treatment.

VNS for treatment-resistant depression

Treatment-resistant depression is a condition defined by depressive disorders that do not respond to two or more different types of medications. In such cases, a doctor may consider other therapies, such as VNS.

VNS was officially approved for treatment-resistant depression in 2005, though the procedure was also noted to help treat symptoms of depression in people with epilepsy before this.

Like other major surgeries, VNS may carry side effects and risks following the initial procedure. These may include:

  • pain
  • skin discoloration
  • swelling
  • nerve damage
  • infection

You may also experience temporary side effects from the device, such as:

  • tickling in your throat
  • coughing
  • hoarse voice
  • shortness of breath

There are also long-term side effects related to the device and treatment to consider. Call a doctor if you experience the following side effects that are not getting better:

  • pain in your neck or throat
  • worsening cough
  • changes to your voice
  • muscle spasms, including in your throat
  • tingling or numb skin
  • changes in your heart rate
  • headache
  • indigestion
  • nausea or vomiting
  • insomnia
  • drowsiness
  • difficulty swallowing
  • changes in the stimulation itself

Finally, it’s important to contact a doctor right away if you’re experiencing worsening seizures or symptoms of depression.

First, a doctor will carefully determine if you are a good candidate for VNS. If you have not tried at least two different medications for your condition, you may not yet qualify for the procedure.

VNS also isn’t recommended for people with the following conditions:

If a medical professional deems you a good candidate for VNS, they will then help you prepare for the surgery. This involves the temporary discontinuation of certain medications and supplements that increase bleeding, as well as fasting the night before the scheduled procedure.

When undergoing VNS surgery, these are the steps you can expect to occur before, during, and after the procedure:

Before the procedure

Before the procedure, a nurse will check your vitals and get you prepared for surgery. You will likely be given general anesthesia to put you to sleep during the procedure.

During the procedure

During VNS, a neurosurgeon will make a small incision along the upper-left portion of the chest area to make room for the pulse generator.

Then, they will make another incision along the crease of your lower neck to make room for the small wire to connect horizontally back to the implant.

In all, the actual surgery involving VNS takes between 45 and 90 minutes to complete.

After the procedure

Immediately after the procedure, you will be taken to a recovery room and monitored for any complications.

It’s important to note that the actual device may not be activated until 2 to 4 weeks after surgery, though it may be activated immediately following implantation in some cases. In either case, the neurosurgeon will program the device electronically on a computer.

For epilepsy, your neurosurgeon may recommend a device model that allows you to swipe a magnet in front of your chest if you feel a seizure coming on. Doing so may help increase the electrical pulses sent through your vagus nerve and possibly stop the seizure from progressing.

Overall, VNS is considered a long-term treatment option for epilepsy and treatment-resistant depression. You may not see results for up to several months, and you should continue to see your doctor for follow-up appointments, as recommended.

For example, some people with epilepsy may not experience improvement in seizures for 2 years after starting VNS. Others might see improvements in as little as 3 months, though.

As with epilepsy treatment, the full effects of VNS for treatment-resistant depression can take time. The majority of people have seen their symptoms improve after 1 year, although it’s also possible to experience the opposite effect after treatment.

The battery in the VNS device has an average life span of up to 15 years. After this time, you may require a less invasive surgery to help replace it.

Also, as long as you have the VNS device, you will need to take care with certain procedures in the future, including MRI. Talk with a doctor before undergoing any tests or procedures to determine if it is safe to do so.

VNS involves sending electrical pulses to your brain with the help of your vagus nerve. If you have treatment-resistant depression or epilepsy, a doctor might consider you a candidate for this procedure, barring any contraindications.

The implantation of a VNS device involves major surgery, for which a doctor will help you prepare. Once you have recovered, it may take several months to notice a difference in your symptoms. You will also need to be on the lookout for associated risks and side effects.

If you have concerns at any stage of your VNS treatment, it’s important to talk with a healthcare professional right away.