Epilepsy comprises a set of neurologic and systemic disorders characterized by recurrent spontaneous seizures, and is the most frequent chronic neurologic disorder. In patients with medically refractory epilepsy, therapeutic options are limited to ablative brain surgery, trials of experimental antiepileptic drugs, or palliative surgery. Vagal nerve stimulation is an available palliative procedure of which the mechanism of action is not understood, but with established efficacy for medically refractory epilepsy and low incidence of side-effects. In this paper we discuss the recommendations for VNS use as suggested by the Brazilian League of Epilepsy and the Scientific Department of Epilepsy of the Brazilian Academy of Neurology Committee of Neuromodulation.Keywords: epilepsy, palliative procedures, vagus nerve stimulation. ResuMOAs epilepsias compreendem uma família de doenças neurológicas e sistêmicas que se apresentam com crises espontâneas repetitivas, sendo a doença neurológica crônica mais frequente. Em pacientes com epilepsias refratárias ao tratamento medicamentoso, as opções terapêuticas são restritas a cirurgia ablativa, estudos experimentais com novas drogas antiepilépticas ou cirurgias paliativas. A estimulação do nervo vago (VNS) é um procedimento paliativo disponível, cujo mecanismo de ação é ainda desconhecido, mas com eficácia estabelecida em pacientes com epilepsias refratárias ao tratamento medicamentoso, apresentando baixos índices de efeitos colaterais. Neste artigo apresentamos o posicionamento do Comitê de Neuromodulação da Liga Brasileira de Epilepsia e do Departamento Científico de Epilepsia da Academia Brasileira de Neurologia sobre as indicações de uso do VNS Palavras-chave: epilepsia, procedimentos paliativos, estimulação do nervo vago.

Epilepsy is a potentially devastating brain disorder characterized by a predisposition to spontaneous epileptic seizures. In patients with medically refractory epilepsy, new non-pharmacological therapeutic approaches may be considered. In this scenario, palliative surgery such as vagus nerve stimulation (VNS) or deep brain stimulation (DBS) may be indicated in a subset of patients. In this paper we make recommendations for the use of VNS and DBS in patients in Brazil with refractory epilepsy.

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