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Review
. 2025 Sep 10.
doi: 10.1007/s10072-025-08446-7. Online ahead of print.

VNS treatment in super-refractory status epilepticus: report of two cases and systematic review of literature

Luca Bosisio  1   2 , Giulia Barbagallo  3   4 , Lino Nobili  1   2 , Gianluca Piatelli  5 , Mattia Pacetti  5 , Matteo Cataldi  1 , Silvia Buratti  6 , Maria Margherita Mancardi  1 , Alessandro Consales  5
Affiliations
Review

VNS treatment in super-refractory status epilepticus: report of two cases and systematic review of literature

Luca Bosisio et al. Neurol Sci. .

Abstract

Background: super-refractory status epilepticus (SRSE) is a rare and severe neurological condition associated with high mortality and significant long-term morbidity. In many cases, conventional medical treatments prove ineffective, with wide use of off-label therapies.

Methods: two researchers conducted a review of the medical records of subjects who had undergone VNS implantation in our tertiary Centre. Additionally, we performed a comprehensive search of the PubMed/MEDLINE and Embase databases. Only manuscripts published in English were included in the review.

Results: seventeen studies, encompassing 64 subjects (including the two patients from our series), met the inclusion criteria. The mean age at the time of VNS implantation was 17.3 years, and 52% of subjects admitted for SRSE had a prior history of epilepsy. The mean number of anti-seizure medications used before VNS implantation was 7, with a median duration of the status of 26 days prior to VNS. VNS led to the resolution of SRSE in 84% of subjects (93% of those with convulsive SRSE and 83% with non-convulsive SRSE). In terms of parameters applied, we found the following median values: Amperage: 1.75 mA; frequency: 30 Hz; Pulse Width: 500 uSec; Duty cycle: 16%; Time On: 30 sec and Time Off: 5 min.

Conclusion: VNS can be an effective treatment option in individuals with SRSE unresponsive to medical treatment.

Keywords: Anti-Seizure-Medication; Super-refractory Status-Epilepticus (SRSE); Vagal nerve stimulation (VNS).

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Conflict of interest statement

Declarations. Ethical approval: none, this is a systematic review of previous published cases and it was conducted according to the 1964 Declaration of Helsinki. Informed consent: we have acquired the informed consent of cases described. Conflict of interest: this study was partly conducted in the framework of the ERN EpiCARE. The authors declare no conflict of interests.

References

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