Vagus nerve stimulation: a 20-year Australian experience

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epilepsy Management

Background:

• Vagus nerve stimulation (VNS) therapy, approved in the mid-1990s, shows efficacy in pediatric populations.
• Limited studies assess VNS outcomes beyond two years in children.
• Small pediatric cohort sizes restrict generalizability of current outcome assessments.

Purpose of the Study:

• To evaluate long-term outcomes and complications of VNS therapy in a large pediatric cohort.
• To assess VNS efficacy and safety over a 20-year period.
• To identify factors influencing VNS therapy outcomes in children.

Main Methods:

• Retrospective review of pediatric VNS insertions from 1999-2020.
• Inclusion criteria required a minimum of 1-year follow-up.
• Assessment included demographics, epilepsy details, seizure outcomes, and complications.

Main Results:

• Over 7 years of follow-up, 51.3% achieved ≥50% seizure reduction; 73.7% had Engel III outcome or better.
• 14.9% were seizure-free, and 81.6% retained long-term therapy.
• Side-effects occurred in 17.1%, but cessation was rare (3.9%); most cessation (13.2%) was due to minimal benefit.

Conclusions:

• VNS therapy provides significant long-term benefit for a majority of pediatric patients.
• Most patients retain VNS therapy, with minimal benefit being the primary reason for cessation.
• Outcomes are not influenced by underlying demographics, epilepsy etiology, or seizure type.