Driving after vagus nerve stimulation therapy: Is it possible?

Driving is consistently reported as an important goal for people with epilepsy. We sought to determine the proportion of people with drug-resistant epilepsy (DRE) who became medically fit to drive after treatment with vagus nerve stimulation (VNS). We conducted a retrospective observational study of consecutive patients treated with VNS attending our neuromodulation clinic. We classified patients as either "VNS responders without additional intervention" or "VNS responders with additional intervention" and determined if patients were eligible to drive Group 1 vehicles (cars, motorcycles, and light work vehicles) under Irish Medical Fitness to Drive regulations. Among 87 patients treated with VNS for ≥12 months, 15 became medically eligible to drive: five were current drivers, three were learner drivers, and seven were eligible to drive based on their seizure control but were not driving for various reasons. Eleven were seizure-free, three had nondisabling focal seizures with preserved consciousness, and one had exclusive sleep-related seizures. Eleven were "VNS responders without additional intervention," while four achieved eligibility after adding ASM or following subsequent epilepsy surgery, while VNS was still active. No patients reported driving-related accidents. ASM burden remained unchanged post-VNS. VNS was well tolerated, and no patients discontinued treatment. In this cohort, 17.2% of patients treated with VNS became eligible to drive, despite it being considered a palliative treatment. These findings highlight the potential role of neuromodulation in improving seizure control and promoting patient autonomy and independence. PLAIN LANGUAGE SUMMARY: This study investigated whether people with refractory epilepsy in Ireland could become eligible to drive after VNS treatment. In our single-center cohort, 17.2% of patients treated with VNS for at least 12 months were eligible to drive at last follow-up. Most achieved this without increasing their medication after VNS implantation. These findings suggest that VNS, often considered a palliative treatment, can help some patients regain independence through improved seizure control.