Adults · Conditions
Epilepsy surgery and VNS in adults
For seizures that continue despite medication: assessment for resective surgery, and vagus nerve stimulation (VNS).
What is it?
Epilepsy is a tendency to have recurrent seizures. About one in three people continue to have seizures despite trying two or more suitable medications (drug-resistant epilepsy). For some, surgery can reduce seizures or, in selected cases, stop them.
What symptoms can it cause?
Seizures take many forms, from brief absences or episodes of altered awareness to convulsions. Drug-resistant epilepsy can affect work, driving, independence and safety.
How is it assessed?
Assessment is carried out with neurologists in an epilepsy team and may include video-EEG monitoring, MRI, neuropsychological testing and sometimes further tests (such as PET or invasive EEG) to find where seizures start and whether that area can be safely treated.
What are the treatment options?
• Resective surgery: when seizures start in one area that can be removed safely (for example in some temporal lobe epilepsy, or a seizure-causing lesion such as a tumour or cavernoma), removing that area can stop or greatly reduce seizures.
• Vagus nerve stimulation (VNS): a small device placed under the skin of the chest, with a wire to the vagus nerve in the neck, which sends regular mild electrical pulses. It is used when resective surgery is not suitable. It does not usually stop seizures completely but can reduce their number and severity over time. Implantation is a short operation, and intraoperative monitoring is used as indicated.
When might surgery be considered?
Surgery may be considered when seizures continue despite appropriate medication. Whether resective surgery or VNS is suitable depends on the assessment, and the decision is made with you and the epilepsy team.
What to expect from recovery and follow-up
After VNS implantation most people go home within a day; the device is switched on and adjusted gradually in clinic. Hoarseness or a change in voice during stimulation is common and usually mild. After resective surgery, hospital stay is longer. Epilepsy medication usually continues, and driving rules after seizures still apply.
When to seek urgent help
If you have a sudden severe headache, a seizure, new weakness, confusion, difficulty speaking, or loss of bladder or bowel control, go to the nearest emergency unit or call 10177. If you are under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600). A seizure lasting more than five minutes, or repeated seizures without recovery in between, is an emergency.
Dr Labuschagne's publications on this topic
- Zanello M, Voges B, Chelvarajah R, et al (incl. Labuschagne J). Right-sided vagus nerve stimulation: worldwide collection and perspectives. Ann Clin Transl Neurol. 2025;12(3):565-576.
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- Labuschagne J, Mutyaba D, Nel J, Casieri C. Intra-operative monitoring as an adjuvant to standard vagus nerve stimulation implantation. Childs Nerv Syst. 2021;37(12):3809-3816.
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- Labuschagne JJ, Hammer N. Intra-operative detection of a left-sided non-recurrent laryngeal nerve during vagus nerve stimulator implantation. Medicina. 2020;56(10):489.
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- Labuschagne JJ. Vagus nerve stimulation: lead revision on a naïve segment of the vagus nerve. Neuromodulation. 2019.
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- Dörschner J, Pelz JO, Kerner AM, Labuschagne JJ, Hammer N, Löffler S. Comparing the accuracy of ultrasound-based measurements of the cervical vagus nerve. Sci Rep. 2023;13(1):884.
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This page is general information. Your doctor will advise on what applies to you.