NICE has now issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on vagus nerve stimulation for refractory epilepsy in children.


Vagus nerve stimulation is used in children and adults with epilepsy, particularly complex partial epilepsy that remains incapacitating despite maximal anti-epileptic medication. The technique has also been used in children with medically refractory encephalopathic seizures, idiopathic seizures, primary generalised epilepsy and the Lennox-Gastaut syndrome, which is a young onset epileptic disorder characterised by multiple seizures types and developmental delay.

Epilepsy prevalence is 2% to 5% worldwide (World Health Organisation estimate). About 5% to 30% of people with epilepsy have medically refractory complex partial seizures.  

A battery powered pulse generator device is implanted under the skin of the upper left chest. A wire is tunnelled under the skin and connected to the left vagus nerve in the neck (surgery time 45 minutes to 2 hours). Stimulation parameters (pulse width and frequency, current intensity, on/off cycles) are programmed into the pulse generator via a programming wand. Patients or carers may then switch the stimulator on and off by passing a magnet over the generator. The battery lasts 8–12 years and can be replaced under local anaesthetic. A typical treatment regimen might comprise intermittent stimulation for 30 seconds every 5 to 10 minutes throughout the day and night.

Coding recommendations

A33.1 Introduction of neurostimulator into cranial nerve

Z04.4 Vagus nerve (x)

In addition an ICD-10 code from category G40.- Epilepsy is assigned.