Epilepsy (Non-US)—The 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 seizure medications. The Model 106 AspireSR™ (Seizure Response) features the Automatic Stimulation Mode, which is intended for patients who experience seizures that are associated with cardiac rhythm increases known as ictal tachycardia.
The VNS Therapy system cannot be used in patients after a bilateral or left cervical vagotomy. Do not use short-wave diathermy, microwave diathermy, or therapeutic ultrasound diathermy on patients implanted with the VNS Therapy system.
Diagnostic ultrasound is not included in this contraindication. Injury or damage can occur during diathermy treatment whether the VNS Therapy system is turned “ON” or “OFF.”
Cardiac arrhythmia (Model 106 only)—The AutoStim Mode feature should not be used in patients with clinically meaningful arrhythmias or who are using treatments that interfere with normal intrinsic heart rate responses (e.g., pacemaker dependency, implantable defibrillator, beta adrenergic blocker medications).
Physicians should inform patients about all potential risks and adverse events discussed in the VNS Therapy Physician Manuals, including information that VNS Therapy may not be a cure for epilepsy. Since seizures may occur unexpectedly, patients should consult with a physician before engaging in unsupervised activities, such as driving, swimming, and bathing, or in strenuous sports that could harm them or others. The safety and efficacy of the VNS Therapy system has not been established for uses outside of its approved indications. A malfunction of the VNS Therapy system could cause painful or direct current stimulation, which could result in nerve damage. Patients should use the magnet to stop stimulation if they suspect a malfunction, and contact their physician immediately for further evaluation. Removal or replacement of the VNS Therapy system requires an additional surgical procedure. Patients who have pre-existing swallowing, cardiac, or respiratory difficulties (including, but not limited to, obstructive sleep apnea and chronic pulmonary disease) should discuss with their physicians whether VNS Therapy is appropriate for them since there is the possibility that stimulation might worsen their condition. VNS Therapy may also cause new onset sleep apnea in patients who have not previously been diagnosed with this disorder. Postoperative bradycardia can occur among patients with certain underlying cardiac arrhythmias. MRI can be safely performed; however, special equipment and procedures must be used.
The safety and efficacy of The VNS Therapy System has not been established for use during pregnancy. Patients who smoke may have an increased risk of laryngeal irritation. There is a risk of infection with the implantation surgery that may require the use of antibiotics to treat or removal of the device. The VNS Therapy System may affect the operation of other implanted devices, such as cardiac pacemakers and implanted defibrillators. Possible effects include sensing problems and inappropriate device responses. If the patient requires concurrent implantable devices, careful programming of each system may be necessary to optimize the patient's benefit from each device. With the Model 106 only, because the device senses changes in heart rate, false positive detection unrelated to seizure activity (e.g., exercise) may cause unintended stimulation. The Model 106 also may not detect all seizures.
The most commonly reported side effects from stimulation include hoarseness (voice alteration), paresthesia (prickling feeling in the skin), dyspnea (shortness of breath), sore throat and increased coughing. Other adverse events reported during clinical studies as statistically significant are ataxia (loss of the ability to coordinate muscular movement); dyspepsia (indigestion); hypesthesia (impaired sense of touch); insomnia (inability to sleep); laryngismus (throat, larynx spasms); nausea; pain; pharyngitis (inflammation of the pharynx, throat); and vomiting. These typically occur only during stimulation, are well tolerated and noticed less as time goes on. The most commonly reported side effect from the implant procedure is infection. Adverse events reported in clinical investigation of the AutoStim feature were comparable.
*THE INFORMATION CONTAINED IN THIS SUMMARY REPRESENTS PARTIAL EXCERPTS OF IMPORTANT PRESCRIBING INFORMATION TAKEN FROM THE PRODUCT LABELING. THE INFORMATION IS NOT INTENDED TO SERVE AS A SUBSTITUTE FOR A COMPLETE AND THOROUGH UNDERSTANDING OF THE VNS THERAPY SYSTEM NOR DOES THIS INFORMATION REPRESENT FULL DISCLOSURE OF ALL PERTINENT INFORMATION CONCERNING THE USE OF THIS PRODUCT. PATIENTS SHOULD DISCUSS THE RISKS AND BENEFITS OF VNS THERAPY WITH THEIR HEALTHCARE PROVIDER. PRESCRIPTION ONLY - DEVICE RESTRICTED TO USE BY OR ON THE ORDER OF A PHYSICIAN.