Abstract
Objective: To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years.
Methods: We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology.
Results: VNS is associated with a >50% seizure reduction in 55% (95% confidence interval [CI] 50%–59%) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50% seizure reduction in 55% (95% CI 46%–64%) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50% seizure frequency reduction rates of ∼7% from 1 to 5 years postimplantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95% CI 1.0–11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time.
Recommendations: VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation.
GLOSSARY
- AAN=
- American Academy of Neurology;
- AE=
- adverse effect;
- BDI=
- Beck Depression Inventory;
- CI=
- confidence interval;
- FDA=
- US Food and Drug Administration;
- JME=
- juvenile myoclonic epilepsy;
- LGS=
- Lennox-Gastaut syndrome;
- SUDEP=
- sudden unexpected death in epilepsy;
- VNS=
- vagus nerve stimulation
Footnotes
Approved by the Guideline Development Subcommittee on January 12, 2013; by the Practice Committee on February 7, 2013; and by the AAN Board of Directors on June 11, 2013.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received February 20, 2013.
- Accepted in final form April 29, 2013.
- © 2013 American Academy of Neurology
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