Power of the Vagus Nerve: How VNS Therapy Offers Hope for Epilepsy and Depression

What Is Vagus Nerve Stimulation (VNS)?

The vagus nerve is the 10th cranial nerve, extending from the brainstem to major organs, including the heart, lungs, and digestive system. It serves as the body’s communication pathway, transmitting information between the brain and the rest of the body. VNS therapy involves using an implanted or external device to send controlled electrical impulses to the vagus nerve. These impulses help regulate abnormal brain activity, reduce seizures, and improve mood by influencing neurotransmitters like serotonin and norepinephrine.

This therapy is FDA-approved for the following conditions:

• Drug-resistant epilepsy (in children aged 4 years and older and adults)
• Treatment-resistant depression (in adults who have not responded to multiple antidepressants)

How Does VNS Work?

When the vagus nerve is stimulated, signals travel to key areas of the brain, including the thalamus, hypothalamus, and limbic system. This stimulation helps to:

• Reduce hyperexcitability in epilepsy patients
• Enhance mood-regulating circuits in individuals with depression
• Improve brain plasticity and recovery

While the exact mechanisms are still being researched, long-term clinical trials indicate that VNS can reduce the frequency of seizures by 50% or more in many patients and help individuals with severe depression experience meaningful improvements after several months of therapy.

Types of VNS Devices

There are different types of VNS systems available today:

Implantable VNS Devices

These devices are surgically placed under the skin in the chest and connected to the left vagus nerve in the neck. The main models include:

• VNS Therapy® (LivaNova) – the most widely used system globally.
• AspireSR® – automatically detects seizure-related changes in heart rate and delivers stimulation.
• SenTiva® – a next-generation model with advanced programming, day/night cycles, and responsive features.

Non-Invasive VNS Devices (tVNS / nVNS)

 These devices do not require surgery and stimulate the vagus nerve externally:

•  GammaCore® (electroCore) – a handheld device applied to the neck, FDA-cleared for treating migraines and cluster headaches.
•  Auricular tVNS devices – stimulate the vagus nerve branches in the ear and are used in research for epilepsy and mood disorders.

Emerging Devices

• Closed-loop VNS systems are being developed that will detect seizure activity in real-time and deliver targeted stimulation.

Who Is a Candidate for VNS Therapy?

For Epilepsy Patients:

• Individuals who have failed at least two anti-seizure medications
• Patients with drug-resistant epilepsy who are not suitable candidates for brain surgery
• Children aged 4 years and older with uncontrolled seizures

For Depression Patients:

• Adults with major depressive disorder who have not improved with four or more medications
• Patients with chronic or recurrent depression

Not Suitable For:

• Individuals with severe heart rhythm issues
• Patients who are unfit for anaesthesia
• Those who have undergone bilateral vagotomy

Benefits of VNS Therapy  

• Seizure Control: Many patients experience a 50–70% reduction in seizure frequency.  
• Improved Quality of Life: Patients often see fewer hospitalisations, reduced seizure severity, and improved mood.  
• Adjunctive Therapy: VNS can be used in conjunction with medications, potentially allowing for dosage reductions.  
• Long-Term Effectiveness: The benefits of VNS often increase over time, unlike some drug therapies.  
• Mood Stabilisation: VNS has a positive impact on mood and alertness, even in patients with epilepsy.  

Risks and Side Effects

While VNS is generally safe, patients may experience:  

• Hoarseness or voice changes  
• Throat discomfort during stimulation  
• Mild coughing or shortness of breath  
• Surgical risks, such as infection or bleeding  
• Rarely, a device malfunction or issues with the leads  
• Most side effects tend to diminish after adjustments to device programming.  

VNS Procedure: Step-by-Step 

1. Pre-Surgery Evaluation: A neurologist or psychiatrist evaluates and confirms candidacy.  

2. Implant Surgery: A small generator is placed under the skin in the chest area, and a wire is connected to the vagus nerve in the neck. Duration: 1–2 hours.  

3. Programming: The device is activated 2–4 weeks post-surgery and is customised by the doctor.  

4. Follow-Up: Regular outpatient visits are required to adjust settings for maximum benefit.  

5. Battery Replacement: Depending on the device model, replacement is needed every 5–10 years.  

VNS Therapy Cost in India

One major reason patients travel to India for VNS is its affordability.  

Average Cost: USD 20,000 – 30,000 (includes device, hospital stay, surgeon, and follow-up)  

Factors Affecting Cost:

• Type of device (SenTiva, AspireSR, Standard VNS)  
• Choice of hospital (public vs. private) 
• Additional investigations (MRI, long-term EEG)  

Always request an itemised quotation that includes:  

• Device cost  
• Surgery charges  
• Hospital stay  
• Post-operative programming  

Top Hospitals for VNS in India 

India hosts several world-class epilepsy and neurosurgery centres:  

• Medanta – The Medicity, Gurugram: Renowned for epilepsy surgery.  
• Apollo Hospitals, Chennai & Hyderabad: Leading private chain with comprehensive epilepsy care.  
• Fortis Hospitals (Delhi, Mumbai, Bangalore): Advanced facilities for neurosurgery.  
• Max Super Speciality Hospital: Strong programs in neurology and epilepsy.  

Top Doctors for VNS Therapy in India

Several neurosurgeons and epileptologists perform VNS implants; notable names include:  

• Dr. V. P. Singh at Medanta, Gurugram (specialist in epilepsy surgery and neuromodulation)
• Dr Sandeep Vaishya / Dr Rana Patir at Fortis Memorial Research Institute

Here is a list of the leading neurosurgeons who specialise in performing this surgery.

Tip: Always choose a doctor involved in a dedicated epilepsy surgery program rather than a general neurosurgeon.  

Why International Patients Choose India for VNS

• Affordable Cost: Treatment in India can be 60–80% cheaper than in the USA or Europe.  
• Experienced Doctors: India has some of the most skilled neurosurgeons in Asia.  
• Modern Hospitals: NABH & JCI-accredited hospitals with cutting-edge technology.  
• Short Waiting Times: Quick scheduling available for international patients.  
• English-Speaking Staff: Facilitates easy communication and patient-friendly services.  
• Medical Tourism Support: Assistance available for visas, accommodation, translators, and follow-up.  

VNS Beyond Epilepsy and Depression 

Research continues into VNS applications for:  

• Migraines & cluster headaches (using non-invasive devices)  
• Stroke rehabilitation  
• Chronic pain syndromes  
• Inflammatory conditions  

While promising, these uses remain experimental and are not considered standard treatment.  

Conclusion: Is VNS Right for You?

Vagus Nerve Stimulation therapy has transformed the lives of thousands of patients with epilepsy and depression worldwide. In India, treatment is available at world-class hospitals at a fraction of the cost found globally.  

If you struggle with uncontrolled seizures or treatment-resistant depression, VNS may be worth discussing with a specialist. 

Quick Checklist Before Choosing VNS in India:  

• Confirm your candidacy through a comprehensive evaluation.  
• Select a hospital with a dedicated epilepsy program.  
• Obtain an itemised cost estimate (including device type).  
• Plan for long-term follow-up visits to adjust the device as needed.  

With the right doctor and hospital, VNS therapy in India can lead to a safer, healthier, and more independent life.