Abstracts

The provision of a service to implant and manage vagus nerve stimulators (VNS) creates a demand on resources which can rapidly escalate. To meet this demand our service has evolved over a decade from a small addition to the epilepsy surgery program to one with its own infrastructure. The authors have implanted over 250 new devices in nearly ten years. Initial assessment started within the main epilepsy surgery program and VNS was offered to those not suitable for resective surgery. A stand-alone clinic now sees referrals specifically with a view to VNS. Videotelemetry and MRI is carried out to confirm the nature of the seizures and exclude the possibility of a resectable focus. Patients are then seen in groups of six with their carers and relatives to discuss VNS and to learn about the implantation and post-operative management. Surgery is carried out as a day-case in a dedicated out-patient surgery facility. Ramping-up of the output current is performed in a nurse-led clinic over a period of about 12 weeks, and a telephone support service is provided.
Contact is maintained with the referring neurologist and they retain the supervision of drug therapy throughout. If the battery fails and the benefit of VNS is equivocal, a neurologist-led re-implantation assessment helps the patient decide if replacement is appropriate. Patient questionnaires have produced highly favourable responses to the changes, the group clinics receiving a particularly positive assessment. Nurse-led follow-up has allowed ramping up to be faster and has ensured the maintenance of the link with the referring neurologist. Continuity of the supervision of drug treatment is therefore ensured. Day-surgery implantation has abolished the overnight hospital stay with no specific problems encountered. Provision of a VNS service generates a large amount of patient contact and a dedicated VNS infrastructure allows this to be provided in an efficient and effective way.