Nutritional status and functional gastrointestinal disorders in pediatric patients with drug-resistant epilepsy: Impact of vagus nerve stimulation.

PURPOSE: To evaluate the nutritional status and functional gastrointestinal disorders (FGIDs) in children with drug-resistant epilepsy (DRE) and determine whether vagus nerve stimulation (VNS) influences gastrointestinal outcomes.

METHODS

This cross-sectional study included 98 pediatric patients with DRE (30 with VNS and 68 without). Anthropometric status was assessed using LMS-derived Z-scores, and FGIDs were diagnosed according to the Rome IV criteria. Logistic regression and ROC analyses were used to investigate the relationship between antiseizure medication (ASM) burden and constipation.

RESULTS

Each additional ASM increased the odds of constipation by 1.63 (95 % CI: 1.08-2.47; p = 0.021). A cutoff of ≥3 ASMs demonstrated a moderate predictive value for constipation (AUC 0.63). Earlier epilepsy onset was significantly associated with lower weight, height, and BMI Z-scores (all p < 0.05). Despite the higher ASM burden, children treated with VNS did not exhibit an increased frequency of gastrointestinal adverse effects.

CONCLUSION

ASM polytherapy is a measurable risk factor for constipation in pediatric DRE, and early epilepsy onset is associated with impaired growth. The absence of increased gastrointestinal symptoms among VNS recipients, despite a higher medication load, suggests a potential modulatory role of vagal neuromodulation. These findings highlight the need for routine nutritional surveillance and structured gastrointestinal assessments and support future longitudinal studies incorporating objective GI measures and biomarker-based evaluations.