Vagus Nerve Stimulation

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In 1997 vagus nerve stimulation was approved by the US FDA for use as adjunctive therapy for adults and adolescents over 12 years of age whose partial-onset seizures are refractory to antiepileptic medications. Vagus nerve stimulation was then also approved in European Union countries

Multiple Subpial Transection

Figure 5.23 Technique of multiple subpial transection. (a) After a tiny incision is created in the pia, a hook is inserted down one gyral edge. (b) It is then swept across the full width of the gyrus. (c) The hook is brought back to its starting point such that the tip is just visible under the pia as it crosses the gyrus. (d) The procedure is repeated at intervals of less than 5 mm along the gyrus leaving thin but visible scars. Thus, the transverse fibres only are sectioned, preserving the columnar organization.

Figure 5.23 Technique of multiple subpial transection. (a) After a tiny incision is created in the pia, a hook is inserted down one gyral edge. (b) It is then swept across the full width of the gyrus. (c) The hook is brought back to its starting point such that the tip is just visible under the pia as it crosses the gyrus. (d) The procedure is repeated at intervals of less than 5 mm along the gyrus leaving thin but visible scars. Thus, the transverse fibres only are sectioned, preserving the columnar organization.

for use in reducing the frequency of seizures in patients of any age whose epileptic disorder is dominated by partial seizures (with and without secondary generalization) or generalized seizures. Its use has grown rapidly in the past 5 years, and it is now the second most common epilepsy surgery procedure carried out in Great Britain (after temporal lobectomy). By August 2003 over 22,000 patients had been implanted with vagus nerve stimulation worldwide. There is no clear idea how vagus nerve stimulation influences epileptic seizures (which are, after all, a cortical phenomenon) but there is considerable experimental and clinical data now confirming that there is an observable, albeit modest, effect.

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