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Wound check can be done locally."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":7,"max":14,"unit":"days","qualifier":"Incision check, often with suture removal if non-absorbable sutures used."}},{"purpose":"assessment","requirement":"routine","after":{"min":14,"max":28,"unit":"days","qualifier":"Device activation and start of stimulation titration, commonly 2-4 weeks after implantation; subsequent adjustment visits follow."}}],"indications":["Drug-resistant epilepsy, adjunctive, when resective surgery unsuitable or ineffective","Treatment-resistant depression after multiple failed antidepressant trials"],"main_risks":["Surgical site infection, hematoma or pain at incision","Vocal cord paresis; vagus or cervical nerve injury, facial weakness","Bradycardia or asystole during intraoperative lead testing (rare)","Swallowing difficulty, aspiration, worsening sleep apnea","Lead fracture or device malfunction requiring reoperation","Anesthesia-related risks"],"pain":"Moderate incisional discomfort in the neck and chest/axilla for several days, usually managed with oral analgesics. Stimulation-related throat tingling or voice changes may occur after activation.","preparation":["Specialist evaluation confirming drug-resistant epilepsy or treatment-resistant depression and suitability","Preoperative assessment for general anesthesia, including medical history review","Fasting before general anesthesia as instructed","Review other implants and planned imaging; device affects MRI","Counseling on expected benefits, delayed onset, and battery replacement"],"recovery_timeline":[{"phase":"Day of surgery to first week","description":"Overnight admission; incisional soreness, neck swelling and transient hoarseness or swallowing discomfort are common.","restrictions":["Keep incisions dry and follow wound care instructions","Avoid heavy lifting and vigorous neck movement"]},{"phase":"Weeks 2-4","description":"Incisions heal; stimulation is typically switched on and gradually increased at clinic visits.","restrictions":["Avoid strenuous upper-body exercise until cleared"]},{"phase":"Months 1-12","description":"Stimulation settings are optimized stepwise and response is monitored.","restrictions":[]}],"rehabilitation_days":{"min":7,"max":14,"unit":"days","qualifier":"Ordinary functional recovery from implantation surgery; no formal rehabilitation program is usually required."},"result_longevity":"Therapy is ongoing while the device is active. Generator battery typically lasts several years depending on model and settings, and replacement surgery is needed when depleted; individual response varies.","revision_rate_pct":{"min":5,"max":15,"unit":"percent","qualifier":"Reoperation for lead or device malfunction, infection or repositioning, excluding planned battery replacement; within several years."},"scars":"Two small incisions: one in the left neck (often along a skin crease) and one in the upper chest or axilla for the generator; usually fade to fine scars.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"One surgical implantation procedure; later programming visits are follow-up care."},"stages":[{"code":"implantation","label":"Implantation of lead on left vagus nerve and pulse generator","after":{"min":0,"max":0,"unit":"days","qualifier":"Day of surgery"}}],"qualifier":"Standalone initial implantation; battery replacement and stimulation titration are separate."},"success":{"metric":"Patients with at least 50% seizure reduction","value":50,"unit":"percent of patients","horizon":"1-2 years after implantation","population":"Adults with drug-resistant epilepsy not suitable for resective surgery","evidence_status":"limited"},"techniques":[{"name":"Implantable cervical vagus nerve stimulator (lead on left cervical vagus nerve with chest-wall pulse generator)","suits_whom":"Adults with drug-resistant epilepsy or selected treatment-resistant depression who meet device criteria.","recovery":"Usually brief hospital stay; return to light activity within about 1–2 weeks."}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":1,"max":2,"unit":"hours","qualifier":"Operative time for a single primary implantation of lead and generator under general anesthesia."},"initial_assessment_documents":["Neurologist report with epilepsy or depression diagnosis","List of failed antiseizure or antidepressant drugs","Brain MRI report","EEG report","ECG report or cardiac history summary"],"travel_trips":{"min":1,"max":2,"one_trip_possible":true,"qualifier":"Implant surgery with 2-5 night stay. Activation 2-4 weeks later; a local neurologist avoids a second trip."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Confirm the surgeon is trained and experienced in the exact procedure you are considering, not just in surgery generally","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Verify that the surgeon is trained and experienced in performing the procedure you are considering.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C2","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C3","text":"Check that the surgeon who consults with you is the same person who will carry out the procedure","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Check that the surgeon you consult with, will be the same person carrying out the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C4","text":"Expect two consultations with the treating surgeon before any surgery, which also gives you time to reconsider","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"You should have 2 consultations with the surgeon treating you before any surgery.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C5","text":"Ask whether a doctor is always present in the clinic and whether a high dependency or intensive care unit exists","scope":"treatment_abroad","source":{"url":"https://www.bapras.org.uk/public/patient-information/cosmetic-surgery/cosmetic-surgery-abroad","host":"bapras.org.uk","quote":"Is there always a doctor in the clinic and is there a high dependency or intensive care unit?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Heart stops beating (cardiac arrest)","urgency":"emergency","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/17598-vagus-nerve-stimulation","host":"my.clevelandclinic.org","quote":"Your heart may stop beating ( cardiac arrest ).","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W2","text":"Muscle weakness in the lower face","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/17598-vagus-nerve-stimulation","host":"my.clevelandclinic.org","quote":"Muscle weakness in your lower face (facial muscle paresis).","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W3","text":"Shortness of breath or trouble breathing","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/17598-vagus-nerve-stimulation","host":"my.clevelandclinic.org","quote":"Coughing. Hoarseness. Change in voice. Neck pain or throat pain or tickling. Shortness of breath/trouble breathing ( dyspnea ).","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T2","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must 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tests and follow-up appointments must be carried out.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"alternatives":{"status":"missing","reason":"no_official_source","checked_at":"2026-11-13","next_check_at":"2027-02-11"},"technique_details":{"status":"ok","items":[{"id":"implantable-cervical-vagus","name":"Implantable cervical vagus nerve stimulator (lead on left cervical vagus nerve with chest-wall pulse generator)","how_it_works":{"text":"An implanted device sends electrical pulses to the neck nerve","source":{"url":"https://my.clevelandclinic.org/health/treatments/17598-vagus-nerve-stimulation","host":"my.clevelandclinic.org","quote":"Vagus nerve stimulation (VNS) uses an implantable device to stimulate the vagus nerve in your 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