ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
The impact of vagus nerve stimulation on the most disabling seizures: A retrospective study in adults with drug-resistant epilepsy.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the long-term efficacy of vagus nerve stimulation (VNS) in reducing tonic-clonic seizures (TCS), drop attacks, and seizure clusters in adults with drug-resistant epilepsy (DRE).
methodsThis retrospective, single-center study included adults with DRE who received VNS and had ≥ 12 months of follow-up. Data were collected pre-implantation (T0), at 12 months (T1), and last follow-up (T2). Outcomes included reduction in total seizure frequency and severity, frequency of TCS and drop attacks, and frequency/duration of seizure clusters. Battery replacement and tolerability were also assessed.
resultsEighty-seven subjects (51 males, median age 33 at T0) with a mean follow-up of 8 years were analyzed. At T2, 54% showed reduced total seizure frequency and 71% reported decreased severity/duration. Among those with baseline TCS, 75% (T1)-80.6% (T2) had frequency reduction, with 20.6% seizure-free at T2. Drop attacks improved in > 70% of cases, with resolution in 21.8% at T2. Over 80% with seizure clusters reported decreased frequency/duration at both T1 and T2. Response rates for specific seizure types significantly exceeded non-response (p < 0.001). Battery replacement was required in 85.7% near depletion. Side effects occurred in 49.4%, mostly mild/transient; major complications were rare.
conclusionVNS exerts a robust effect on the most disabling seizures-TCS, drop attacks, and seizure clusters-surpassing its impact on overall seizure burden. Benefits appear within the first year and persist long term. These findings support a more tailored approach to VNS candidate selection, advocating earlier use in patients with refractory, harmful seizures not eligible for curative surgery.
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