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Vagus nerve stimulation (VNS) remains an established neuromodulation option for people with drug-resistant epilepsy who are not suitable candidates for resective surgery. In an early multicentre randomized study, patients with refractory partial seizures were assigned to high-output therapeutic VNS or a lower-output control paradigm while continuing their antiseizure medicines. The therapeutic stimulation group achieved a greater reduction in seizure frequency than the low-output group, establishing proof of efficacy for chronic VNS. The trial was important because it demonstrated that a neuromodulation strategy could provide additional seizure control without requiring removal of brain tissue. VNS does not usually produce seizure freedom in most patients, and benefit can take time to emerge. For HCPs, the practical role of VNS is therefore as an adjunctive therapy in carefully selected drug-resistant epilepsy, particularly when a focal resection is unsuitable or has failed. Patient counselling should cover realistic expectations, device-related adverse effects and the need for ongoing medication review. The study remains relevant to IANCON's focus on refractory epilepsy and emerging treatment options.
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Vagus nerve stimulation (VNS) remains an established neuromodulation option for people with drug-resistant epilepsy who are not suitable candidates for resective surgery. In an early multicentre randomized study, patients with refractory partial seizures were assigned to high-output therapeutic VNS or a lower-output control paradigm while continuing their antiseizure medicines. The therapeutic stimulation group achieved a greater reduction in seizure frequency than the low-output group, establishing proof of efficacy for chronic VNS. The trial was important because it demonstrated that a neuromodulation strategy could provide additional seizure control without requiring removal of brain tissue. VNS does not usually produce seizure freedom in most patients, and benefit can take time to emerge. For HCPs, the practical role of VNS is therefore as an adjunctive therapy in carefully selected drug-resistant epilepsy, particularly when a focal resection is unsuitable or has failed. Patient counselling should cover realistic expectations, device-related adverse effects and the need for ongoing medication review. The study remains relevant to IANCON's focus on refractory epilepsy and emerging treatment options.
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