Safety and effectiveness of vagus nerve stimulation in patients with drug-resistant epilepsy: a single center experience.

Abstract

Background: Drug-resistant epilepsy (DRE) exerts substantial clinical, humanistic and economic burdens on patients, their families and the healthcare system. Vagus nerve stimulation (VNS) has been extensively tested in clinical trial settings to decrease the frequency of seizures in patients with DRE who are not candidates for surgery; the results indicate promising efficacy and a well-tolerated safety profile. However, real-world evidence is still lacking. This retrospective study evaluated the safety and efficacy of VNS in patients with DRE.

Methods: The current study was a retrospective chart review of the medical records of children and adults with DRE treated with VNS between December 2006 and November 2022. The primary outcome of the present study was the percentage of patients who experienced a reduction in seizure frequency of more than 50% compared with the frequency at baseline (the period before VNS device insertion).

Results: A total of 103 patients were included. The percentage of patients who achieved a reduction of more than 50% in seizure frequency was 23% at six months, 36% at 12 months, 65% at 18 months, and 72% at 24 months. Similarly, the percentage of patients with complete resolution of interictal epileptiform discharges (IEDs) increased from 30% at six months to 60% after 24 months. The overall Quality of Life in Epilepsy (QOLIE-31) score at the end of follow-up was 39.46 ± 13.68 points. Two patients (1.9%) reported experiencing side effects at the end of follow-up.

Conclusions: VNS implementation led to a significant reduction in the seizure frequency and resolution of IEDs, with a well-tolerated safety profile. The findings highlight the potential role of VNS in managing DRE and warrant its consideration for treating patients with DRE.