Practical Considerations for the rapid titration of VNS

For patients with drug-resistant epilepsy who are not candidates for epilepsy surgery, Vagus nerve stimulation (VNS) is the most widely available neuromodulation option and has been available in several countries for 30 years. Given its broad availability and extended history on the market, many healthcare providers (HCPs) have developed individualized practice habits regarding the titration and dosing of VNS. This study provides novel evidence to describe the extent to which VNS management differs among providers and discusses recent literature that indicates how unique programming approaches may impact patient outcomes. In this work, practice habits regarding the titration and dosing of VNS were explored through a survey of HCPs and an examination of ongoing study data collected as part of the CORE-VNS Study. The global survey revealed significant variability in dosing and titration habits. Providers reported a wide range of initial/maximum target doses and time-to-dose, even if the population averages approximated guidance from professional societies and the manufacturer's labeling. Variable dosing and titration were reflected in varied perception of how long it takes to realize the clinical benefits of VNS. In the CORE-VNS Study, this reported experience was represented in how different generator models were used, with users of SenTiva (and the Scheduled Programming feature) depicting faster time-to-dose than those using earlier models of VNS. Our results suggest VNS providers would benefit from continued training on the use of VNS and the use of the scheduled programming feature to enhance consistency of VNS management among providers.