Focus of the Report: Vagus nerve stimulation (VNS) is used as an adjunct to antiepileptic drugs (AEDs) for the treatment of seizures uncontrolled by medical management, epileptic surgery, or other interventions such as ketogenic diets.

Technology Description: VNS requires the surgical implantation of a pulse generator under the skin of the chest, connected to an electrode in the left vagus nerve in the neck. Following impedance testing, a subcutaneous pocket is created below the clavicle or just medial to the axilla and superior to the breast, along with a tunnel to the cervical incision for the lead wires. Patients are normally discharged 1 day after surgery. VNS modulates concentrations of neurotransmitters across multiple regions of the brain, leading to a reduction in the frequency and severity of seizures.

Controversy: VNS has a long history of use for the treatment of epilepsies, but the highest-quality evidence is largely restricted to older patients. In pediatric patients with TRE, VNS is limited to largely retrospective, open-label studies with relatively restricted sample sizes. VNS may represent a less invasive surgical alternative to open surgical resections.

Key Questions:

  • Is VNS effective for treatment-resistant epilepsy (TRE) in pediatric patients?

  • Does the effectiveness of VNS for TRE vary by age in pediatric patients?

  • How does VNS compare with alternative interventions for pediatric patients with TRE?

  • Is VNS safe for the treatment of TRE, and are there long-term safety considerations?

  • Have definitive patient selection criteria been established for VNS in pediatric patients with refractory TRE?

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