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What to expect ® with VNS Therapy Adey, On VNS Therapy since 2004 page 1 2 What to expect with VNS Therapy® Now that you have chosen to have VNS Therapy, you probably have questions about your next steps and what to expect. VNS Therapy is not another medication. It is a unique approach for difficult-to-treat epilepsy that has been proven to reduce the number and intensity of seizures. In addition, many people using VNS Therapy have also reported improvements in mood, increased alertness, and enhanced memory. You are not alone in your decision to get VNS Therapy. More than 65,000 people worldwide have chosen this treatment to help control their seizures without the side effects often associated with medications like depression, dizziness, confusion, weight changes, fatigue, insomnia, and low energy. Many people experience long-lasting seizure control with VNS Therapy. It is a safe, effective treatment that usually improves over time. What to expect with VNS Therapy® page 3 page 4 What to expect with VNS Therapy® Understanding VNS Therapy The vagus nerve connects the brain to various parts of the body and has been proven to be a good way to communicate with the brain. VNS Therapy sends messages to the brain through this nerve to help control seizures. A short, outpatient procedure The implant procedure is minimally invasive and typically performed under general anesthesia by a surgeon. A small generator about the size of a watch is placed under the skin usually in the chest area. A thin, flexible wire connects the generator to the vagus nerve in the neck which delivers periodic pulses directly to the brain. The procedure takes about an hour and most people go home the same day. Because the generator is implanted under the skin, you will have your treatment with you all the time. This is an advantage because there’s nothing to take and no schedules to remember. VNS Therapy is with you all day, every day, so you don’t have to worry about it. What to expect with VNS Therapy® page 5 page 6 What to expect with VNS Therapy® VNS Therapy is customized to suit every individual. The VNS Therapy generator is usually turned on 2 weeks after the implant procedure. Your doctor programs the generator to automatically deliver the appropriate dose of stimulation for you. One dose commonly used by physicians is 30 seconds of stimulation every 5 minutes. During routine office visits, your doctor can read and adjust stimulation settings using special computer software and a VNS Therapy programming wand. During each office visit, your doctor will check to make sure the VNS Therapy system is working properly and the stimulation is comfortable for you. What to expect with VNS Therapy® page 7 The VNS Therapy magnet and how it works An added benefit of VNS Therapy is the handheld VNS Therapy magnet. If you or your caregiver recognizes that you are having a seizure or are about to have a seizure, the magnet allows you to immediately activate an additional dose of stimulation so that it potentially shortens, stops, decreases the intensity, or decreases the recovery period of the seizure. Use of the magnet is not necessary to receive VNS Therapy. Holding the magnet over the place where the generator is located for at least two seconds is all it takes. An extra dose of stimulation will begin when you move the magnet away from the generator. The magnet can be conveniently worn on your belt or wrist like a watch. Your doctor or nurse will show you how to use the magnet and answer any questions you may have. Before you can use the VNS Therapy magnet, your doctor must adjust a setting on the generator. This will happen during your first programming appointment. page 8 What to expect with VNS Therapy® Replacing the VNS Therapy generator battery The VNS Therapy generator battery usually lasts 5-8 years, but can change depending on the device settings. A procedure is required to replace the generator once the battery is depleted. The procedure to replace the battery requires only one incision, is also typically done on an outpatient basis, and takes less than an hour. Common side effects of VNS Therapy The most common side effects of VNS Therapy may include a feeling of hoarseness or changes in voice tone, coughing, a tickling sensation in the throat or on the neck, and a feeling of shortness of breath. These side effects generally occur only when the generator is on and usually decrease over time. The magnet can be used to turn off the generator to temporarily control page 10 What to expect with VNS Therapy® these side effects during activities such as public speaking, singing, or exercising if needed. If you experience troublesome or painful side effects from VNS Therapy for an extended period of time, you should contact your doctor. There is a minor risk of infection from the implantation procedure, which is similar to any other minimally invasive procedure. Precautions with VNS Therapy • Talkwithyourdoctorbeforeyouhaveanymedicalteststhatmight affect, or be affected by, the VNS Therapy system. If you’re unsure, always ask your doctor. • T alkwithyourdoctorbeforeyouhaveanyothermedicaldevices implanted. • T ellyourdoctorifyounolongerfeeltheroutinestimulation.Your doctor may decide to change the generator settings. • PeoplewithVNSTherapyshouldnotuseshort-wavediathermy, microwave diathermy, or therapeutic ultrasound diathermy. Be sure to inform any healthcare professional that you should not have diathermy treatment. • P eoplewithVNSTherapymusttakespecialprecautionsbeforehaving an MRI (Magnetic Resonance Imaging) scan. Talk with your doctor before having an MRI. • B eforeundergoinganymedicalprocedure,notifyyourhealthcare provider that you have VNS Therapy. A full list of warnings and precautions are included in the Patient’s Manual in your kit, or available on our website at www.VNSTherapy.com. What to expect with VNS Therapy® page 11 Your VNS Therapy checklist As you move forward with VNS Therapy, the following steps are important. Make sure your insurance coverage has been authorized •Askyourdoctor Get pre-operation instructions •Askyoursurgeon Schedule a follow-up visit with your surgeon •Makeanappointmenttovisityoursurgeonafterthe implantation procedure •Askaboutpost-operativeinstructions Schedule a follow-up visit with your neurologist •Makeanappointmenttovisityourneurologistafterthe implantation procedure Take your Patient Essentials Kit home from the hospital along with your post-operative instructions page 12 •ThePatientEssentialsKitcontainsyourPatient’sManual, VNS Therapy handheld magnets, and a wallet-sized Patient EmergencyCard •Tellyourdoctorimmediatelyifyoudonotreceiveyourkitat the hospital What to expect with VNS Therapy® Talk to someone who has VNS Therapy. Join our monthly Phone Facts conference call to talk with VNS Therapy patients and other people thinking about getting VNS Therapy. On this call, you can get firsthand information about the procedure and learn what it feels like to have VNS Therapy. An epilepsy specialist is available for every session. You do not have to provide your name, even if you wish to ask questions. All calls are free and confidential. Calls take place the first Tuesday of every month, 7:00 PM Central Standard Time: 1-877-451-8943. You can also join us on Facebook www.facebook.com/ VNSTherapyforEpilepsy What to expect with VNS Therapy® page 13 Safety Information for VNS Therapy INTENDEDUSE/INDICATIONS—UNITEDSTATES Epilepsy:TheVNSTherapySystemisindicatedforuseasanadjunctivetherapyinreducing the frequency of seizures in adults and adolescents over 12 years of age with partial onset seizures which are refractory to antiepileptic medications. CONTRAINDICATIONS 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.” WARNINGS Physicians should inform patients about all potential risks and adverse events discussed in The VNS Therapy System Physician’s Manual 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. Patients should avoid excessive stimulation (>4 hours of continuous stimulation due to repeated magnet activations) and manipulation of the Pulse Generator and Lead through the skin. A malfunction of The VNS Therapy System could cause painful or direct current stimulation. Removal of The VNS Therapy System requires an additional surgical procedure. page 14 What to expect with VNS Therapy® 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. Patients with The VNS Therapy System or any part of The VNS Therapy System implanted should not have a full body MRI. PRECAUTIONS 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. ADVERSEEVENTS 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. 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. *THEINFORMATIONCONTAINEDINTHISSUMMARYREPRESENTSPARTIALEXCERPTS OFIMPORTANTPRESCRIBINGINFORMATIONTAKENFROMTHEPRODUCTLABELING. THEINFORMATIONISNOTINTENDEDTOSERVEASASUBSTITUTEFORACOMPLETE ANDTHOROUGHUNDERSTANDINGOFTHEVNSTHERAPYSYSTEMNORDOESTHIS INFORMATIONREPRESENTFULLDISCLOSUREOFALLPERTINENTINFORMATION CONCERNINGTHEUSEOFTHISPRODUCT.(CAUTION—U.S.FEDERALLAWRESTRICTS THISDEVICETOSALEBYORONTHEORDEROFAPHYSICIAN.) What to expect with VNS Therapy® page 15 Call toll-free: 1-888-VNS-STIM 8 6 7-7 8 4 6 Or visit www.VNSTherapy.com You can also join us on Facebook www.facebook.com/ VNSTherapyforEpilepsy www.cyberonics.com CYBERONICS, INC. 100 Cyberonics Boulevard Houston, Texas 77058 Tel: +1.800.332.1375 Fax: +1.281.218.9332 CYBERONICS EUROPE Belgicastraat 9 1930 Zaventem, Belgium Tel: +32.2.720.95.93 Fax: +32.2.720.60.53 ©2012 Cyberonics, Inc. All rights reserved. Cyberonics® and VNS Therapy® are registered trademarks of Cyberonics, Inc. PtExp13-11-2000-US