Related Experiment Video
Updated: May 5, 2026
Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
Published on: January 7, 2019
Predictors of response to vagus nerve stimulation in childhood-onset medically refractory epilepsy
Ravindra Arya1, Hansel M Greiner2, Amanda Lewis2
1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Ravindra.Arya@cchmc.org.
Insights
Predictors of vagus nerve stimulation (VNS) response in childhood epilepsy were identified. Nonlesional patients and shorter epilepsy duration before VNS implantation showed better seizure control outcomes.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neurosurgery
Background:
- Childhood-onset epilepsy presents unique challenges for treatment.
- Vagus nerve stimulation (VNS) is an established therapy for refractory epilepsy.
- Predicting VNS response is crucial for optimizing patient care.
Purpose of the Study:
- To identify predictors of response to vagus nerve stimulation in children with epilepsy.
- To evaluate the impact of epilepsy duration and neuroimaging findings on VNS outcomes.
Main Methods:
- Retrospective chart review of patients with new VNS implantation (2006-2011).
- Primary outcome: change in seizure frequency (International League Against Epilepsy scale).
- Statistical analysis including logistic regression and ROC curve analysis.
Main Results:
- 67.4% of patients achieved significant seizure reduction (Class 4 or better).
- 9.3% achieved complete seizure freedom.
- Absence of MRI lesions (OR 6.07) and shorter epilepsy duration (OR 1.29) predicted better outcomes.
- Model demonstrated good predictive fit (AUC 0.80).
Conclusions:
- Nonlesional status and shorter epilepsy duration are significant predictors of favorable VNS outcomes in childhood epilepsy.
- These findings can aid in patient selection and counseling for VNS therapy.
- Further prospective studies are warranted to confirm these predictors.
Abstract:
This study explored predictors of response to vagus nerve stimulation in childhood-onset epilepsy. This retrospective chart review included all patients with new vagus nerve stimulator insertion between January 1, 2006, and December 31, 2011. Primary outcome was change in seizure frequency classified on the International League Against Epilepsy scale. Overall, 67.4% (95% confidence limits 53.3%-81.6%) of the patients had outcome of class 4 or better, and 4 patients (9.3%, 95% confidence interval 0.5%-18.1%) achieved complete seizure freedom (mean follow-up 3.5 y). Absence of magnetic resonance imaging (MRI) lesion (odds ratio 6.068, 95% confidence interval 1.214-30.329, P = .028) and duration of epilepsy before implantation (odds ratio 1.291, 95% confidence interval 1.015-1.642, P = .038) were found to be statistically significant predictors of good outcome and provided a sufficient fit to the data (area under the receiver operating characteristic curve .80, Hosmer-Lemeshow goodness of fit P = .92). This study provides preliminary evidence that nonlesional patients are significantly more likely to have better outcome with vagus nerve stimulation.
