ArticleEpilepsia open2026
Effects of vagus nerve stimulation and epilepsy surgery on antiseizure medication usage in pediatric patients with drug-resistant epilepsy in the real world: A retrospective nationwide cohort study.
Article in Epilepsia open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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4 authors.
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Abstract
objectiveThe long-term effects of epilepsy surgery (ES) or vagus nerve stimulation (VNS) on antiseizure medication (ASM) usage and status epilepticus (SE) diagnosis in real-world pediatric drug-resistant epilepsy (DRE) populations remain unclear. This study aimed to provide a more comprehensive understanding of how VNS and ES affect ASM usage and SE manifestations in pediatric DRE.
methodsWe conducted a nationwide, retrospective cohort study using the Korean Health Insurance Review and Assessment Service database from January 1, 2007, to December 31, 2022. Pediatric patients (<18 years) diagnosed with DRE were categorized into ASM-only, VNS, and ES groups. Changes in ASM usage and SE diagnostic rates were assessed.
resultsA total of 6075 pediatric patients with DRE were included (ASM-only, n = 5407; VNS, n = 217; ES, n = 451). Although the VNS and ES groups had more severe epilepsy at baseline, both interventions significantly reduced ASM usage, albeit with distinct trajectories. ES led to a sharp reduction in ASM usage immediately postoperatively, followed by stabilization, with approximately one-third of the patients discontinuing ASM by the end of follow-up. VNS stabilized ASM usage rather than reducing it, with fewer than 10% of patients discontinuing ASM. Both interventions were associated with significant decreases in SE diagnostic rates after the intervention (p = 0.007 and 0.02, respectively), but no statistically significant difference was found in the overall SE rates among the three groups (p = 0.18). SIGNIFICANCE: These findings demonstrate that VNS and CES positively impact ASM usage, reduce the incidence of SE, and underscore the need for timely intervention to optimize outcomes. PLAIN LANGUAGE SUMMARY: We studied children with drug-resistant epilepsy who were treated with either vagus nerve stimulation (VNS) or brain surgery for epilepsy. We found that brain surgery often led to a large and lasting reduction in seizure medication, whereas VNS helped stabilize medication use. Both treatments were linked to fewer cases of status epilepticus, a severe type of seizure emergency. These findings suggest that VNS and surgery may help reduce medication burden and protect against serious seizures in children with hard-to-treat epilepsy.
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