King’s College Hospital in south London has become the first centre in Europe to implant a new generation brain stimulation device that uses scheduled programming to suppress the frequency and severity of epileptic seizures.
King’s has a long history of treating patients with medication-resistant epilepsy who are not candidates for direct surgery to the brain. The treatment used is Vagus Nerve Stimulation (VNS). VNS involves implanting a small device in the chest and connecting it to the vagus nerve in the neck where it delivers electrical impulses to the brain to relieve seizures.
The current delivered is gradually increased by a doctor in during outpatient appointments and the programming cycle is changed to optimise the management of seizures. The patient or carer is able to ‘swipe’ the device with a magnet when a seizure occurs to deliver a booster dose of stimulation, and since January 2015 the device has also been able to continuously monitor heart rate and deliver additional stimulation when a rise in heart rate consistent with a seizure occurs. VNS has been shown to be effective in decreasing the frequency and severity of seizures, allowing a decrease in medication, and in improving patients’ quality of life.
The new device allows the doctor to programme it in a more flexible manner. Multiple steps can be pre-programmed to occur at specified times in the future so that the patient is not required to attend as many outpatient appointments. The device can also be programmed to deliver different stimulation patterns at different times of the day or night, according to the patient’s condition. In outpatient appointments the doctor is able to download the record of seizure detections from the device and see the pattern by date and even hour of the day.
Dr David McCormick, Consultant Paediatrician in Epilepsy and Neurorehabilitation, and a leading expert on VNS therapy said, “Implantable technology will play a key part in the future of personalised medicine. This implanted device is the next generation treatment for patients with drug-resistant epilepsy. We are hopeful that it will offer further improvements in seizure control and quality of life for patients.”
Nine-year-old Surrey schoolboy, Simukai Shambira, was the first patient in Europe to have the new device implanted, Simukai has Lissencephaly, a rare genetic condition characterised by the absence of the normal folds in the brain, which results in several seizures per day.
His father, Valentine Shambira, who lives in Wallington, Surrey with his wife Felistas, Simukai and two younger sons, and said, “Simukai was on three different types of medication to control his seizures but he became resistant to the medication so we had to find a different treatment, which was when the team at King’s College Hospital told us about this new technology.
“We hope this device will reduce the number of seizures Simukai experiences each day. The fits slow him down and make him very drowsy so he misses out at school. We don’t live near the hospital so not having to attend appointments as frequently will help us to have more of a normal family life.”
Dr McCormick added, “This device is win-win: it means fewer hospital appointments for patients and this also means that over time it will save the NHS money. The device is also smaller than the ones we have used previously so it is less obvious underneath the skin.”