Blog # 161: WEEKLY EPILEPTIC SEIZURES REDUCED BY MEDICAL CANNABIS

 

A study was summarized by Robert Herpen, MA and Shenaz Bagha on the American Epilepsy WebSite. The researchers, Xintian Lyn, BS, a student in the department of experimental and clinical pharmacology at the College of Pharmacy at the University of Minnesota and her team reported on their recent poster at the American Epilepsy Society meetings earlier in December 2023 that adults with epilepsy given medical cannabis had a significant decrease in weekly seizure frequency.¹

There is a paucity of data on the effects of THC (Tetrahydrocannabinol, the principal psychoactive constituent of cannabis) on seizure frequency. This researcher group in Minnesota was interested in cannabis’ effects on seizure frequency.

From 2016 to 2019 one-hundred-twelve adults with epilepsy, 70% of whom were aged 18-64 (54.5 % were male) were studied. The participants had at least four visits for treatment for at least 6 months. They may or may not have had antiseizure medications prescribed, too. The outcome of the study was that 57 participants reported fewer weekly seizures, 47 enrollees reported no change—including 34 with zero frequency seizures during the study period—while 10 patients reported an increase in their seizure frequency. In all three of these groups, participants were dispensed both CBD (cannabis) and THC. The study found a significant difference reported in CBD total daily dose among those who recorded either a decrease or no change in seizure frequency. CBD is a chemical found in marijuana. CBD doesn't contain tetrahydrocannabinol (THC), the psychoactive ingredient found in marijuana that produces a high.

Thirty patients relied on only CBD cannabis to manage their epileptic seizures. Most of this study population were also taking one to five antiseizure medications.

If your epilepsy is poorly controlled discuss adding CBD (cannabis) to your treatment with your physicians. Additionally, explore the potential of brain surgery as your epilepsy treatment if no other treatments benefit you. Several of my previous 160 monthly blogs on my website: LanceFogan.com dealt with brain surgery as a chance to improve your epilepsy when medications fail (See Blog # 89 December 26, 2017: Surgical Removal of Seizure Foci in Your Brain to Cure Poorly Controlled Epilepsy is Safe!; Blog # 103 February 26, 2019: Epilepsy—fit to drive?; Blog # 114 January 26, 2020: Epilepsy surgery in childhood and long-term employment is encouraging.; Blog # 121 August 25, 2020: If your seizures aren’t controlled epilepsy surgery is safe and really can help).

 

1.      Lyu X. et al. Medical cannabis and seizure control in Minnesota medical cannabis program. Presented at AmericanEpilepsy Society annual meeting Dec. 1-5, 2023: Orlando, FL.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

Blog #160: Life Expectancy Varies by Epilepsy Type

 

Overall, life expectancy is comparable to the general population.¹ But in certain types of epilepsy, the risk of premature death is higher than that of the general population. Most of the increased risk is directly related to what causes your epilepsy.

Only a small number of deaths in the epilepsy patient population are epilepsy related. These are deaths caused by a seizure or accidents during or immediately after the seizure, as well as sudden unexpected death for which no cause of the death can be identified. SUDEP (see below) is one example of this. Sudden unexpected deaths are more common in patients with poorly controlled, intractable epilepsy. Improved seizure control, medical advice and avoiding the hazards that occur during a seizure are key. Regular medical follow-up care and supervision may help reduce the risks of epilepsy-related death occurring.

What causes epilepsy?

Epilepsy can be categorized into three broad groups:

Idiopathic epilepsy

Common among children, idiopathic epilepsy is an inherited type of epilepsy with a strong genetic component and no structural brain abnormalities. Provoked seizures (for example, from flashing lights) are often seen in idiopathic epilepsy.

Cryptogenic epilepsy

Cryptogenic epilepsy is the type with no known cause and often involves unprovoked seizures. This accounts for approximately 20% of seizure cases.

Symptomatic epilepsy

Symptomatic epilepsy is caused by an injured brain. Common causes: head injuries, central nervous system infections, loss of oxygen to the brain, strokes, brain tumors and brain surgery.

How can your epilepsy result in premature death?

Premature deaths in people living with epilepsy: failure to take antiseizure medications as prescribed; the seizures themselves; collateral damage related to a seizure; reduced quality of life that comes with living with epilepsy; fatal unintentional injuries (for example, falls and burns), or through aspiration pneumonia during a seizure.

Additionally:

Serious transportation accidents: Seizures — which can result in impaired awareness and uncontrolled motor activity — put people living with epilepsy at increased risk of serious transportation accidents. This increased risk doesn’t apply to just car accidents but to the increased risk of pedestrian accidents and increased risk of bicycle accidents.

Drowning: because seizures can lead to a loss of consciousness or uncontrolled motor activity, people living with epilepsy are at increased risk of drowning. The risk of drowning is much higher in people with epilepsy. Despite my warnings, one of my young surfer patients ignored this warning and continued surfing. I don’t know his current condition While cases of drowning often occur in the bathtub (Mark Twain’s adult daughter had epilepsy; she drowned in her bath, for example), less frequently patients die in the shower; the body, face-down, blocks the drain resulting in drowning in just inches of water.

Status epilepticus: status epilepticus is a condition in which a person experiences abnormally prolonged seizures (longer than five minutes in the case of generalized tonic-clonic seizures; they usually last under 2 minutes) that can lead to long-term consequences, including brain damage and death.

Psychiatric illness: people with epilepsy commonly have depression, which increases the risk of suicide. The high incidence and prevalence of psychiatric illness (including impulsivity, psychosis, and substance abuse) correlates with the duration and severity of epilepsy. Depression is also associated with not taking medications as recommended, which can increase mortality.

What is a sudden unexpected death in epilepsy (SUDEP)? Premature mortality in people with epilepsy can also be attributed to a sudden unexpected death in epilepsy (SUDEP): Blog #108: SUDEP—Sudden Death in Epilepsy—Occurs in All Types of Epilepsies; Blog #74: New Studies Reveal High SUDEP Risk of Death in Poorly Controlled Epilepsy. In the US, there are at least 2,750 cases of SUDEP per year. SUDEP refers to deaths among people with epilepsy that cannot be attributed to other known causes. Studies suggest that for every 100,000 people with epilepsy, there will be approximately 116 cases of SUDEP. While the causes of SUDEP are not yet fully understood, most cases occur during or immediately after a seizure and generally during sleep. Possible seizure-related factors contributing to SUDEP include breathing and/or heart rhythm disruptions.

Does epilepsy shorten your life expectancy? People with epilepsy are two to three times more likely to die early than those without the condition. This suggests that epilepsy can shorten life expectancy by ten years for those living with symptomatic epilepsy and by two years for those with idiopathic/cryptogenic epilepsy where no serious brain pathology can be identified. While life expectancy is reduced in cases of symptomatic epilepsy (by approximately seven years), people with cryptogenic epilepsy had an almost normal life expectancy.

SUMMARY: While epilepsy can increase your risk of premature death, it is possible, in most cases, to manage these risks with anti-epileptic drugs, appropriate mental healthcare, and lifestyle changes. Mortality in patients with newly diagnosed epilepsy is higher than in patients with chronic epilepsy due mainly to the underlying epilepsy cause.

MY ADVICE: making family, friends, and colleagues aware of the risks and how they might be able to help you reduce these risks can go a long way to keeping you safe. Be certain that you have follow-up care and observation by your physician for your best chance of thriving with epilepsy.

1.     Granbichler CA, Zimmerman G, Oberaigner W, et. al. Potential years lost and life expectancy in adults with newly diagnosed epilepsy. Epilepsia. 2017;58(11): 1939-1945.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Blog #159: DO YOU HAVE SUBTLE EPILEPSY SYMPTOMS THAT ARE UNRECOGNIZED?

 

Stacie Kalinoski is an Emmy-award winning reporter. She also is an epilepsy nurse practitioner. In the April/May 2018 issue of the patient-geared journal Brain and Life, page 56, she writes of her own epilepsy. Kalinoski pursues brain surgery and she documents this journey.

Kalinoski experienced her first convulsion in college. An avid runner, while running she noted regular episodes of déjà vu, that weird feeling like she is in some environment or is seeing something for the very first time, but it felt like that the experience had happened to her before. Most of us have experienced such a feeling once or twice in our lives but frequent recurrent episodes are abnormal. They suggest epileptic auras, a problem in our brain’s temporal lobe. Another brain phenomenon that is similar, but the opposite, is jamais vu. Here, what’s familiar to us no longer feels or seems, familiar. For example, one’s bedroom, one’s car, or familiar people—all feel new during the seconds or minutes of the episode.

Kalinoski’s hidden epilepsy flowered into multiple blank outs after a strenuous marathon run. She had had little sleep. Then she lost awareness and cut herself preparing vegetables. A neurologist diagnosed epilepsy. She started antiseizure medications. Too little sleep and strenuous running accompanied more jamais vu episodes. She became disorientated after a run. She found herself lost despite being very near her house. She required help getting home only two blocks away. Neurological testing showed an abnormal brain focus originating epileptic seizures. A temporal lobectomy followed. This decreased the number of her aura-seizures. These subsequently became episodes of strange tastes lasting a few seconds. Many people also experience auras as smells that aren’t really there—olfactory hallucinations.

In my novel, DINGS, I created a character who has olfactory hallucinations. The neurologist in the novel queried if his young patient had ever imagined smelling something that wasn’t actually there. The neurologist then offered “burning rubber” smells, a common symptom of complex partial seizure auras. The novel’s character agrees that he does perceive smells like that. A diagnosis of epileptic blank-out seizures is made, heretofore unrecognized. The mother is devastated upon learning her son has epilepsy. She conjures up public prejudices. She learns that one percent of the population has epilepsy, over three million Americans, but the epilepsy in half of them, encouragingly, is well controlled. They are free of seizures on treatment. Chief Justice Roberts of the United States Supreme Court, despite his epilepsy, has achieved a leading position in our society.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Blog # 158: POLITICIAN BLANKS ON NATIONAL TV. HAS THIS HAPPENED TO YOU?

 

Many of my patients with epilepsy on follow-up appointments told me, “No. I haven’t had a seizure in over a year now. I’m doing very well.” What they probably are referring to is their past convulsion history. No convulsion has recurred. Is this the whole story? Are they fully aware of their condition.

They may not understand possible brief blank-outs of their awareness or halting of thinking of speaking. did they lose contact mentally with their environment while still not perceiving any focal numbness, weakness/ paralysis, incontinence nor visual problems?

 

         Family and other observers may see or hear the person stop talking, a speech arrest, just as the nation recently saw on their television screens. A prominent politician suddenly froze up, stopped speaking and did not answer the reporter's question directed at him. As this occurred, he inappropriately stared off to the side, with a vacuous expression, unmoving. after a delay of nearly half a minute while his aides mored in alongside, he began to speak again.

 

        What was that? What happened? Accounts state it was his second such

episode in two months. It suggested to me that TV watchers experienced a

man having a seizure, a non-convulsive type. Since the news reported he had 

a similar episode a month before, more than one seizure is compatible with 

epilepsy. If so, was his condition secondary to head trauma? He had fallen a

few months before striking his head. The most common cause of epilepsy in

the population is in the elderly population. See my past blogs on this titled,

Mortality in Older Adults with Epilepsy. 

       News reports stated that seizures and strokes were “ruled out.”

But physicians know that small strokes may not always be visualized on brains scans and neurologists recognize that approximately 50% of people with epilepsy, in whom a single EEG is performed, will have a normal EEG. In such cases, multiple EEGs or continuous EEG recording would be more apt to find an abnormality. Epileptiform abnormalities are not constant in the brain in people with epilepsy. Conclusion: a normal EEG does not rule out epilepsy. The best manner of making a diagnosis of epilepsy is based on the patients’ and observers’ histories.

 

       Physicians will also consider non-convulsive epilepsy mimics such as transient ischemic attacks (TIA) or “mini transient strokes,” low blood sugar, migraine phenomena without headache among other conditions.

       I encourage all epilepsy patients to visit their neurologist/physician with a person close to them if possible. Other people may observe phenomena, clues, of which the patient may be unaware.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

 

Blog # 157: Cognition and dementia in older patients with epilepsy

 

Today’s health care practices have resulted in a substantial rise in the number of older adults with epilepsy. In America we have one percent of our population, three million, suffering with epilepsy. In the rest of the developed world, the elderly over 65 also have the highest incidence of epilepsy. It no longer is the pediatric population that develops the most cases of epilepsy (See my Blog # 15, Epilepsy is most common in the Elderly, at LanceFogan.com)

Older people are more likely to have cognitive decline with epilepsy. There seems to be a relationship between epilepsy and dementia. Epidemiological findings reveal that people with late-onset epilepsy and individuals with Alzheimer’s disease share common risk factors. Medical science isn’t conclusively settled on the cause of Alzheimer’s nor who will develop it but it seems in some people to be mediated by underlying vascular changes in the aging brain. Contributing to their development of epilepsy is their survival after brain trauma, strokes and various diseases.¹

The authors  Sen, Capelli, et.al., suggest that there is considerable intersection between epilepsy, Alzheimer’s disease and cerebrovascular disease raising the possibility that better understanding of shared mechanisms in these conditions might help to ameliorate not just seizures, but also epileptogenesis and cognitive dysfunction.

 

1.     A. Sen, V. Capelli, M. Husain. Cognition and dementia in older patients with epilepsy Brain, Volume 141, Issue 6, June 2018, Pages 1592–1608,  https://doi.org/10.1093/brain/awy022

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Blog # 156: Fatigue and Epilepsy

 

BJ Mac, Medical and Health Writer, and neurologist,  Amit M. Shelat, D.O., reviewed this subject in 2021 and their observations will help explain common symptoms with your epilepsy.¹

Added to your epilepsy, you feel exhausted, tired, or weak. Fatigue is a much more common symptom in people living with epilepsy than in the general population. Feelings of exhaustion and weakness can affect daily quality of life. Understanding this, there are some ways to help manage epilepsy-related fatigue.

What Does Fatigue with Epilepsy Feel Like?

The fatigue felt by people living with epilepsy is characterized by mental and physical experiences of persistent and extreme weakness, tiredness, and exhaustion.

One patient described being more emotional because of fatigue: “Does anyone feel so tired that they feel sad? This often happens to me. I am on a lot of medication, and my seizures are not under control, so I guess I have many reasons to be tired.”

Another patient reported that fatigue causes daytime sleepiness: One patient described the impact of seizure-related fatigue on her quality of life, writing, “For several years, I wake up after a seizure, and I am tired for up to seven days and in bed pretty much all day every day. That is the primary reason I lost my job.”

What Causes Fatigue in Epilepsy?

Several factors can cause a person with epilepsy to experience fatigue.

Depression

Depression is a known comorbidity (co-occurring condition) of epilepsy, with symptoms that vary from person to person. A study² using measures called the Fatigue Severity Scale and Fatigue Impact Scale revealed a high prevalence of depression-related fatigue among people living with epilepsy.

This fatigue may sometimes trigger epileptic seizures. A cycle can start to develop: Depression causes fatigue, which contributes to seizures. These seizures then cause more fatigue, which contributes to depression, and so on. Talk to your doctor about how to treat depression to break this cycle.

Many patients agree that dealing with depression is a common aspect of living with epilepsy: “I never thought I would ever have to deal with depression. With epilepsy, depression is a daily battle.”

Nocturnal Seizures

Another important risk factor of developing fatigue when living with epilepsy is poor sleep or sleep impairment. Nocturnal seizures (seizures that occur while a person is sleeping) can affect a person’s sleep quality.

A person is considered to have nocturnal seizures if more than 90 percent of their seizures occur when sleeping, which is the case in up to 45 percent of people living with epilepsy.

Both generalized and focal seizure types can occur as nocturnal seizures. Nocturnal seizures tend to occur during the first, lighter stages of sleep or upon waking.

One patient described nighttime seizures as a source of fatigue: “I recently had several nocturnal seizures, and I am now very exhausted. It will take three days for my body to get back to normal. It takes so much out of you.”

Another person described how nocturnal seizures interrupt her sleep rhythm and cause fatigue the next day: “Does anyone else ever have a seizure in their sleep and find it hard to fall back asleep? Then during the day, it can completely take your energy away.”

Postictal Fatigue

There are several stages to a seizure:

• Prodromal phase — When symptoms begin.
• Aural phase — When altered perception or sensations occur.
• Ictal phase — The actual seizure.
• Postictal phase — Recovery time after a seizure.
• Interictal phase — The time in between seizures.

Postictal phases have been found to have higher chronic fatigue scores and fatigue impact scores than ictal phases, with people reporting more fatigue and lower energy during the postictal phase. In other words, the recovery period after a seizure is a time of intense fatigue.

Many people reported needing to sleep due to intense fatigue during this phase. “I always go to sleep after a seizure,” wrote one patient. “It’s often compared to running a marathon. Your muscles are weak, everything hurts, and you are plain tired.”

Antiseizure Medications

Antiepileptic drugs commonly cause fatigue. A change of medication or time to adjust to your treatment plan may be needed to reduce this fatigue.

One patient said about medication-related fatigue: “When I took that medication, I experienced fatigue, anxiety, fear, anger, and mood swings.” Offering some great advice: “When side effects become unmanageable, it’s time to talk to your neurologist and ask for a drug that has fewer side effects.”

Managing Epilepsy-Related Fatigue

Managing fatigue with epilepsy can be challenging because its different causes can be interrelated. Tracking symptoms of fatigue and discussing causes and treatments with your health care team is the best place to start.

1)     BJ Mac, Medical and Health Writer, Medically reviewed by
Amit M. Shelat, D.O. 2021

2)     Fatigue in epilepsy: A systematic review and meta-analysis Oh-Young Kwona , Hyeong Sik Ahnb , Hyun Jung Kimb, * a Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea b Institute for Evidence-Based Medicine, Korea University College of Medicine, Seoul, Republic of Korea

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Blog #155: Robot-assisted brain surgery at Canada’s London Health Sciences Centre provides hope for people living with epilepsy.

 

Since 2011, my monthly epilepsy blog followers (LanceFogan.com) have reviewed several blogs touching on the efficacy of epilepsy surgery on improving epilepsy—often cures result. Specialized epilepsy neurosurgical centers evaluate each candidate and if the seizure focus can be localized with various test procedures, and if it is determined that surgery on that focus would be safe without debilitating side-effects, e.g., speech problems, motor, sensory or visual complicating deficits, highly successful outcomes are routine.

Review my most recent epilepsy blogs on epilepsy surgery: blog #145 Aug. 25, ’22; blog#121, Aug 25, ’20, and blog #89, Dec 26, ’17.

 Bryan Bicknell, the CTV News Reporter, on June 23, 2023, reported that a neurosurgeon at the London Health Sciences Centre in London, Ontario, Canada, became the first to perform deep brain stimulation with a robot!

Neurosurgeon, Dr. Jonathan Lau, reported that all three of these robot procedures he has done since January 2023, have been successful. All went home a day or two after the procedure. He likens it to implanting a pacemaker for a bad heart.

“This is the same idea. People with epilepsy have a predisposition to having seizures, so they have irregular rhythms in their brain in terms of electrical activity. So, the same principle applies. An irregular rhythm there, so we put electrodes in the appropriate spots with the aid of the robot which is less intrusive than surgery. The electrodes can restore function and prevent seizures.” Lau said it was almost by accident that he and his team at University Hospital decided to employ it for this specific use.

“It was actually a fairly routine day when we decided, ‘Okay, because we don’t have the other options let’s use the robot.’ So, we inquired a little bit and it turns out nobody had done this for this indication in Canada,” he explained.

Epilepsy is one of the most common neurological disorders in the world, affecting one percent of the population, more than 300,000 Canadians. And not only is there a stigma around the disease itself, but Lau said there’s also a stigma attached to the very surgery to improve life for those living with it. Brain surgery can seem scary, but Lau said new technologies actually make it safer.

“With things like robotic assistance, with improvements in imaging, the risks of the procedure are much, much lower, and it’s just raising that awareness,” he said. Lau added that robot-assisted deep brain stimulation surgery is a treatment for some patients who would not otherwise be considered for surgery. 

This is another road you might consider if your epilepsy is uncontrollable.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

Blog #154: VAGUS NERVE STIMULATION BENEFITS EPILEPSY

An epilepsy diagnosis was made on an 11-year-old girl. Various antiepileptic medications were prescribed but breakthrough tonic-clonic and absence seizures continued. Brain surgery was explored but she was found to have bilateral epileptic foci. Surgery, therefore, was ruled out.¹

A year later Vagus Nerve Stimulation (VNS) was considered a possible treatment. In VNS a battery device is implanted under the skin in the chest and its electrodes are threaded under the skin and then the side of the neck is opened by the surgeon and placed on the left vagus nerve inside the neck. The left and the right vagus nerves course from both sides of the brainstem in the lower part of the skull down to the chest and the stomach. The right vagus nerve, however, is not used as it primarily affects the heart.

The Federal Drug Administration (FDA) has approved vagus nerve stimulation for people who:

• Are 4 years old and older.
• Have focal epilepsy where the brain activity that causes seizures happens in one area of the brain only.
• Have seizures that aren't well-controlled with medicines.

Vagus nerve stimulation also is considered for people with generalized epilepsy.²

Research has shown that VNS theoretically may help control seizures by: Increasing blood flow in key brain areas; raising levels of some brain substances (called neurotransmitters) that are important to control seizures; changing EEG (electroencephalogram) patterns during a seizure.

Stroke recovery: For people who are recovering from a stroke, vagus nerve stimulation has been FDA-approved when combined with rehabilitation. Vagus nerve stimulation paired with rehabilitation may help people recover function in their hands and arms after a stroke.²

Risks:

Having a vagus nerve stimulator implanted is safe for most people. But it does have some risks, both from the surgery to implant the device and from the brain stimulation.

Surgery risks

Surgical complications with implanted vagus nerve stimulation are rare and are similar to the dangers of having other types of surgery. They include:

• Pain where the cut is made to implant the device. 
• Infection. 
• Difficulty swallowing. 
• Vocal cord paralysis. This is usually temporary but can be permanent.

Side effects after surgery:

Some of the side effects and health problems associated with implanted vagus nerve stimulation include: Voice changes. A hoarse voice. Throat pain. Cough. Headaches. Shortness of breath. Trouble swallowing. Tingling or prickling of the skin. Trouble sleeping. Worsening of sleep apnea.

For most people, side effects are tolerable and typically lessen over time. However, some side effects may remain for as long as you use implanted vagus nerve stimulation.

Adjusting the electrical impulses from the battery device under the skin on the chest can help minimize these effects. If you can't tolerate the side effects, the device can be shut off.

Then it can be programmed to deliver electrical impulses to the vagus nerve at various durations, frequencies, and currents. Vagus nerve stimulation usually starts at a low level. It gradually is increased depending on your symptoms and side effects.

Stimulation is programmed to turn on and off in cycles — such as 30 seconds on, five minutes off. You may have some tingling sensations or slight pain in your neck. You also may have a hoarse voice when the device is on.

Results

If you had the device implanted for epilepsy, it's important to understand that vagus nerve stimulation isn't a cure. Most people with epilepsy won't stop having seizures. They'll also likely continue taking epilepsy medicine after the procedure. But many might have fewer seizures — up to 50% fewer. The seizures also may be less intense. It can take months or even a year or longer of stimulation before you notice any significant reduction in seizures. Vagus nerve stimulation also may shorten the recovery time after a seizure. People who have had vagus nerve stimulation to treat epilepsy may experience improvements in mood and quality of life.

1)    Touching a Nerve. Brain and Life April/May 2023 p32-35.

2)    The Mayo Clinic has reviewed VNS at https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.