Skip to main content
  • Potential Predictors of Vagus Nerve Stimulation

    Final Number:

    Ryan Turner BS; William Coggins BS; Jay Jeon; Daniel Branch MD; Zain Allison MD; Thomas Frank MD; Juan Ortega-Barnett MD, FACS, FAANS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: Vagus nerve stimulation (VNS) has steadily grown as an option for treating refractory epilepsy. Unfortunately, considerable variability remains in the success of VNS in patients. Therefore, it is necessary to identify which characteristics increase or decrease the likelihood of successful VNS treatments to mitigate potential complications by performing unnecessary procedures. We examine available literature to determine the known predictors and characteristics of patients in relation to VNS performance.

    Methods: PubMed was queried for articles pertaining to vagus nerve stimulation and predictive variables. Articles included in the review met the following inclusion criteria: clinical data on human subjects in English, articles reporting treatment of seizure disorder with VNS, data that was supported with multivariate analysis. No limit was placed on publication date.

    Results: Younger age at implantation, later onset of epilepsy, and generalized over partial seizures were most strongly supported as predictive of successful therapy. Other potential positive predictors supported by smaller data sets include: lower seizure frequency, duration of epilepsy prior to implantation, unilateral IED or absence of bilateral IED, focal epilepsy, presence of temporal discharges, cortical dysgenesis, Lennox-Gastaut syndrome, post-traumatic epilepsy, and tuberous sclerosis. There are conflicting results regarding the prognostic value of pairwise derived brain symmetry index and the presence of MRI lesions. Indices of heart rate variability are a new and potentially useful predictor of response.

    Conclusions: VNS remains a safe and efficacious method of treating refractory epilepsy. However, as the response is highly variable, there is a need for better understanding of its mechanisms and predictive variables to reduce unnecessary procedures. Though there are many potential VNS predictors, additional corroborative data is needed before these may guide decision making. Thus far, younger age of implantation, later onset of epilepsy, and generalized seizures are the factors most strongly associated with successful VNS therapy.

    Patient Care: Our research identifies potential factors that may be instructive when considering VNS treatment for refractory epilepsy and highlights the need for further study in this area.

    Learning Objectives: By the conclusion of this session, participants should understand: 1) VNS can be a safe and efficacious treatment for refractory epilepsy but the response is highly variable, 2) the current state of the research on predictors of response to VNS for refractory epilepsy, and 3) there is conflicting or insufficient data about many potential predictors of response to VNS

    References: Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. The Lancet Neurology. 2008 Jun 30;7(6):525-37. Moshé SL, Perucca E, Ryvlin P, Tomson T. Epilepsy: new advances. The Lancet. 2015 Mar 13;385(9971):884-98. Amar AP, Heck CN, Levy ML, Thomas S, DeGiorgio CM, Oviedo S, Apuzzo ML. An institutional experience with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome. Neurosurgery. 1998 Dec 1;43(6):1265-76. Arcos A, Romero L, Gelabert M, Prieto A, Pardo J, Osorio XR, Arráez MA. Can we predict the response in the treatment of epilepsy with vagus nerve stimulation?. Neurosurgical review. 2014 Oct 1;37(4):661-8. Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response: a review. Journal of neurosurgery. 2011 Dec;115(6):1248-55. Montavont A, Demarquay G, Ryvlin P, Rabilloud M, Guénot M, Ostrowsky K, Isnard J, Fischer C, Mauguière F. Long-term efficiency of vagus nerve stimulation (VNS) in non-surgical refractory epilepsies in adolescents and adults. Revue neurologique. 2007 Dec;163(12):1169-77. Englot DJ, Rolston JD, Wright CW, Hassnain KH, Chang EF. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy. Neurosurgery. 2015 Nov 28;79(3):345-53. Kim MJ, Yum MS, Kim EH, Lee YJ, Lee J, Hong S, You SJ, soon Hwang Y, Ko TS. An interictal EEG can predict the outcome of vagus nerve stimulation therapy for children with intractable epilepsy. Child's Nervous System. 2017 Jan 1;33(1):145-51. Liu H, Yang Z, Huang L, Qu W, Hao H, Li L. Heart-rate variability indices as predictors of the response to vagus nerve stimulation in patients with drug-resistant epilepsy. Epilepsia. 2017 Apr 25. Ghaemi K, Elsharkawy AE, Schulz R, Hoppe M, Polster T, Pannek H, Ebner A. Vagus nerve stimulation: outcome and predictors of seizure freedom in long-term follow-up. Seizure. 2010 Jun 30;19(5):264-8. Arya R, Greiner HM, Lewis A, Horn PS, Mangano FT, Gonsalves C, Holland KD. Predictors of response to vagus nerve stimulation in childhood-onset medically refractory epilepsy. Journal of child neurology. 2014 Dec;29(12):1652-9. Janszky J, Hoppe M, Behne F, Tuxhorn I, Pannek HW, Ebner A. Vagus nerve stimulation: predictors of seizure freedom. Journal of Neurology, Neurosurgery & Psychiatry. 2005 Mar 1;76(3):384-9. Elliott RE, Morsi A, Kalhorn SP, Marcus J, Sellin J, Kang M, Silverberg A, Rivera E, Geller E, Carlson C, Devinsky O. Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy & Behavior. 2011 Jan 31;20(1):57-63. Lagae L, Verstrepen A, Nada A, Van Loon J, Theys T, Ceulemans B, Jansen K. Vagus nerve stimulation in children with drug-resistant epilepsy: age at implantation and shorter duration of epilepsy as predictors of better efficacy?. Epileptic Disorders. 2015 Sep 1;17(3):308-14. Shahwan A, Bailey C, Maxiner W, Harvey AS. Vagus nerve stimulation for refractory epilepsy in children: more to VNS than seizure frequency reduction. Epilepsia. 2009 May 1;50(5):1220-8. De Vos CC, Melching L, van Schoonhoven J, Ardesch JJ, de Weerd AW, van Lambalgen HC, van Putten MJ. Predicting success of vagus nerve stimulation (VNS) from interictal EEG. Seizure. 2011 Sep 30;20(7):541-5. Hilderink J, Tjepkema-Cloostermans MC, Geertsema A, Glastra-Zwiers J, de Vos CC. Predicting success of vagus nerve stimulation (VNS) from EEG symmetry. Seizure. 2017 Apr 4. George R, Sonnen A, Upton A, Salinsky M, Ristanovic R, Bergen D, Mirza W, Rosenfeld W, Nari-Toku D, Manon-Espaillat R, Barolat G. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology. 1995;45(2):224-30.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy