Children & families · Conditions

Epilepsy and vagus nerve stimulation (VNS)

When seizures continue despite medication, an epilepsy surgery assessment may help.

What is it?

Epilepsy is a tendency to have repeated seizures. Most children are treated with medication by a neurologist. When seizures continue despite medication, an epilepsy surgery assessment may be advised.

What symptoms can it cause?

Seizures vary from brief absences to convulsions. Frequent seizures can affect learning, behaviour and day-to-day life.

How is it assessed?

Assessment is led by a paediatric neurologist and may include EEG recordings, MRI and other tests, discussed at a multidisciplinary meeting.

What are the treatment options?

Options include continuing or changing medication, the ketogenic diet, VNS, or other epilepsy surgery for selected children. VNS uses a small device placed under the skin of the chest, connected to the vagus nerve in the neck, which sends regular gentle pulses that can reduce how often and how severely seizures occur.

  1. In the neck, the left vagus nerve runs inside the carotid sheath, between the carotid artery and the jugular vein, beneath the sternocleidomastoid muscle.
  2. Through a small incision in the neck, soft helical electrodes are wound gently around the left vagus nerve.
  3. A thin lead is tunnelled under the skin to a small generator placed in a pocket below the left collarbone.
  4. The generator sends mild, regular pulses up the vagus nerve to a relay centre in the brainstem (the nucleus tractus solitarius).
  5. From there, signals spread through the brain and, over time, can help make seizures less frequent or less severe. Results vary between patients.

When might surgery be considered?

VNS may be considered when seizures continue despite medication and other epilepsy surgery is not suitable. Dr Labuschagne has published on VNS outcomes in South African children and is a certified VNS proctor and trainer for the African region.

What to expect from recovery and follow-up

Most children go home the next day. The device is switched on and adjusted gradually at clinic visits with the neurology team.

When to seek urgent help

If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is 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 longer than five minutes, or repeated seizures without recovery in between, is an emergency.

Dr Labuschagne's publications on this topic

Consent forms to read in advance

If surgery is recommended, you are welcome to read the relevant form before your consultation. Dr Labuschagne will go through it and sign it with you at the consultation.

All consent forms

This page is general information for parents and caregivers. Your child's doctor will advise on what applies to your child.

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