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Children with drug-resistant epilepsy may require non-pharmacological therapies when seizures remain uncontrolled despite multiple antiseizure medicines and surgery is not feasible. This randomized active-controlled paediatric trial evaluated high-output versus low-output vagus nerve stimulation in 41 children with intractable epilepsy. The study assessed seizure frequency, seizure severity and tolerability during a blinded treatment phase. High-output stimulation produced a greater reduction in seizure burden than the low-output control setting, supporting VNS as an adjunctive treatment in selected children. The study also showed why response should not be judged by a single seizure count: changes in seizure severity and overall clinical function can be relevant even when complete seizure freedom is not achieved. For HCPs, VNS should be considered within a multidisciplinary epilepsy programme that includes syndrome classification, surgical evaluation, developmental assessment and family counselling. The procedure does not remove the need for antiseizure medication, and response varies considerably between patients. Long-term benefit is generally assessed over months rather than days. The trial is particularly relevant to IANCON's emphasis on refractory epilepsy, paediatric epilepsy and neuromodulation.
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Children with drug-resistant epilepsy may require non-pharmacological therapies when seizures remain uncontrolled despite multiple antiseizure medicines and surgery is not feasible. This randomized active-controlled paediatric trial evaluated high-output versus low-output vagus nerve stimulation in 41 children with intractable epilepsy. The study assessed seizure frequency, seizure severity and tolerability during a blinded treatment phase. High-output stimulation produced a greater reduction in seizure burden than the low-output control setting, supporting VNS as an adjunctive treatment in selected children. The study also showed why response should not be judged by a single seizure count: changes in seizure severity and overall clinical function can be relevant even when complete seizure freedom is not achieved. For HCPs, VNS should be considered within a multidisciplinary epilepsy programme that includes syndrome classification, surgical evaluation, developmental assessment and family counselling. The procedure does not remove the need for antiseizure medication, and response varies considerably between patients. Long-term benefit is generally assessed over months rather than days. The trial is particularly relevant to IANCON's emphasis on refractory epilepsy, paediatric epilepsy and neuromodulation.
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