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. 2024 Dec;14(6):e200358.
doi: 10.1212/CPJ.0000000000200358. Epub 2024 Aug 16.

Long-Term Seizure Outcome With or Without Vagal Nerve Stimulation Therapy

Sonia Gill  1 , Kathryn N Devlin  1 , Hsiangkuo Yuan  1 , Scott Mintzer  1 , Christopher Skidmore  1 , Chengyuan Wu  1 , Michael R Sperling  1 , Maromi Nei  1
Affiliations

Long-Term Seizure Outcome With or Without Vagal Nerve Stimulation Therapy

Sonia Gill et al. Neurol Clin Pract. 2024 Dec.

Abstract

Background and objectives: To compare long-term seizure control in patients with long-term VNS (vagal nerve stimulator) stimulation (VNS-on) with those who discontinued VNS after >3 years (VNS-off).

Methods: Patients with refractory epilepsy with VNS therapy for >3 years (and follow-up for >2 years after VNS discontinuation for VNS-off patients) were included. Patients with brain surgery <3 years after VNS were excluded. We compared the percentage of patients with ≥50% seizure reduction (50% responder rate) and change in seizure frequency within and between groups in follow-up.

Results: Thirty-three VNS-on and 16 VNS-off patients were evaluated. VNS-on patients underwent stimulation for 9.7 years (mean). VNS-off patients had VNS treatment for 6.5 years (mean), discontinued treatment, then had additional 8.0 years (mean) follow-up. 50% responder rates were similar between groups (VNS-on: 54.5% vs VNS-off at last-on: 37.5%, p = 0.26; vs VNS-off at the last follow-up: 62.5%, p = 0.60). VNS-on patients had a significant reduction in seizure frequency at the last follow-up compared with baseline (median [Mdn] = -4.5 seizures/month, interquartile range [IQR] = 14.0, 56% reduction, p = 0.013). VNS-off patients also showed significant seizure reduction while still continuing VNS therapy (Mdn = -1.0 seizures/month, IQR = 13.0, 35% reduction, p = 0.020) and, after discontinuing therapy, at the last follow-up compared with baseline (Mdn = -3.2, IQR = 11.0, 52% reduction, p = 0.020). The 2 groups were comparable in seizure frequency change both at the last-on visit (absolute change, p = 0.62; relative change, p = 0.50) at the last follow-up (absolute change, p = 0.67; relative change, p = 0.76).

Discussion: Patients who discontinued VNS therapy and those who continued therapy had similar response during active treatment and similar long-term outcomes, suggesting that factors such as the natural disease course and/or medication treatment strongly affect long-term outcomes.

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Conflict of interest statement

K.N. Devlin (knd52@drexel.edu) has served as a consultant for Neurologic Solutions, Inc., and Diagnostic Driving, Inc., and currently receives research grants from NIH (R01HD096066, P30MH092177); H. Yuan (hsiangkuo.yuan@jefferson.edu) has received funding from NIH (R44NS115460); institutional support for serving as an investigator from Teva, Abbvie, Thermaquil; consultant fees from Salvia, Pfizer, Cerenovus; and royalties from Cambridge University Press and MedLink; C.T. Skidmore (christopher.skidmore@jefferson.edu) has received lecture honoraria from Natus and research support through Neuropace and Jazz Pharmaceuticals; C. Wu (chengyuan.wu@jefferson.edu) is a paid consultant for Medtronic, Boston Scientific, Abbott, Neuropace, Nevro, BrainLab, and NeuroOne; and serves on the Advisory Board for ZetaSurgical; M. Sperling (michael.sperling@jefferson.edu) has received compensation for speaking at CME programs from Medscape, Projects for Knowledge, International Medical Press, and Darnitsa. He has consulted for Medtronic, Neurelis, and Johnson & Johnson. He has received research support from Medtronic; Neurelis; SK Life Science; Takeda; Xenon; Cavion; Cerevel; UCB Pharma; Janssen; Equilibre; and Engage Pharmaceuticals. He has received royalties from Oxford University Press and Cambridge University Press; M. Nei (maromi.nei@jefferson.edu) receives honoraria from MedLink Neurology and has research support through UCB Pharma and Eisai. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

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