ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2026
Surgical re-evaluation patterns among pediatric vagus nerve stimulation non-responders: a single-center retrospective study.
Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 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
objectiveVagus nerve stimulation (VNS) is an established adjunctive therapy for pediatric drug-resistant epilepsy (DRE). While ~ 50% of patients achieve clinically meaningful seizure reduction, non-responders may not undergo further evaluation for additional surgical options, leaving persistent risk for uncontrolled seizures and epilepsy-related morbidity and mortality. We evaluated rates of post-VNS surgical re-evaluation and epilepsy surgery among pediatric VNS non-responders and secondarily assessed seizure and antiseizure medication (ASM) outcomes.
methodsWe performed a retrospective review of pediatric patients with DRE who underwent VNS implantation at our institution (2013-2020). Patients were classified as "responders" if they achieved ≥ 50% seizure frequency reduction from baseline. Variables included demographics, operating surgeon, generator model, revision history, seizure type and frequency, and ASM burden. Groups were compared using chi-square and Student's T-tests.
resultsForty-seven patients (25 responders, 22 non-responders) met inclusion criteria. Groups did not differ significantly in age, sex, race, operating surgeon, generator model, revision history, or baseline ASM burden. At follow-up, responders required fewer ASMs than non-responders (p = 0.03). Among non-responders, only 3/22 patients (13.6%) underwent additional epilepsy surgery (two responsive neurostimulation, one corpus callosotomy), and all achieved meaningful seizure reduction postoperatively. Three deaths occurred in the non-responder group, none surgery-related.
conclusionNearly half of pediatric patients treated with VNS failed to achieve seizure reduction, yet few underwent re-evaluation for further surgical management despite favorable outcomes among those who did. Structured follow-up pathways are needed to ensure timely surgical re-assessment of pediatric VNS non-responders within comprehensive epilepsy programs.
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