Nasser Zangiabadi - Associate professor of neurology
Sara Ahmadi - Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran

VNS indications: Epilepsy: VNS Therapy system is indicated for use as an adjunctive therapy in reducing the frequency of seizures in patients whose epileptic disorder is dominated by partial seizures (with or without secondary generalization) or generalized seizures that are refractory to antiepileptic medications. Depression: VNS Therapy is indicated for the adjunctive long-term treatment of chronic or recurrent depression who are experiencing a major depressive episode and have not had an adequate response to four or more antidepressant treatments. Mechanism of action: VNS definitely exerts an effect via the LC (norepinephrine) and the RN (serotonin) These mechanisms of action are similar to those of medications through pharmacologic pathways The LC and RN/DRN have been conclusively identified as:  Brain centers affected by VNS Therapy  Playing a role in suppressing seizures  Areas that must be intact for VNS Therapy to have an effect VNS Safety Profile More than 70,000 patients worldwide have been implanted with VNS Therapy No known interactions with medications No reported systemic neurotoxic effects, rash, renal impairment, or bone marrow suppression No increase in sudden, unexpected death in epilepsy (SUDEP)1 Gestational outcomes Animal study has shown no evidence of impaired fertility or harm to the fetus due to VNS Therapy2,3 Pregnancies have gone to term with VNS4,5 One of my challenging Cases which resulted in Vague Nerve Stimulation (VNS) therapy 53-year-old Right-handed gentleman with History of epilepsy since 1983 (due to being injured during war) in form of CPS and GTCs. In spite of undergoing LTM for two times, the epileptogenic zone was not clearly identified.So he became a candidate for Invasive Recording.He underwent the Invasive Recording in 2017;but unfortunately it was not helpful for determining the epileptogenic zone. So surgery was not an option for him anymore. Besides, although he was treated with four AEDs with adequate dosage, he had seizure attacks almost every day.Therefore,according to the patient s condition,VNS therapy was recommended for him.We implanted VNS for the first time in Khatam-Al-Anbia hospital about six months ago for this patient. The frequency of the patient’s attacks has been decreased to about sixty-five percent till now. No significant side effects have been reported except for mild hoarseness.