anesthesia and we now recommend that all patients have their VNS turned off during general anesthetic for other reasons. There is also evidence from our clinical experience, and from a study by Malow et al., that during VNS activation, there are decreases in airflow and respiratory effort, which are probably insignificant except in patients with pre-existing obstructive sleep apnoea.

A number of papers show that seizure frequency is reduced but seizures are seldom abolished by VNS. Binnie suggests that a better than 50% reduction in seizures occurs at 18 months in 50% of patients [24]. Similar figures (between 40 and 50%, with a greater than 50% reduction, showing an improvement with time) are given by other authors. Everyone is agreed that sustained freedom from seizures, equivalent to Engel I outcome in resective surgery, is rare, occurring in about 2% of patients. Results in children are also encouraging. In a group of 60 children, a greater than 50% reduction in 42% of them at 18 months has been reported and, in a group of 38 children, 26 had a greater than 50% reduction, 11 of whom had a greater than 75% reduction in seizure frequency. By contrast, the results have been unencouraging in a group of severely disabled children with epileptic encephalopathy. Boon and his colleagues in Ghent have reported a halving of direct epilepsy-related medical costs and reduction to one-third of hospital admissions for patients with VNS.

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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