Surgical re-evaluation patterns among pediatric vagus nerve stimulation non-responders: a single-center retrospective study.

OBJECTIVE

Vagus nerve stimulation (VNS) is an established adjunctive therapy for pediatric drug-resistant epilepsy (DRE). While ~ 50% of patients achieve clinically meaningful seizure reduction, non-responders may not undergo further evaluation for additional surgical options, leaving persistent risk for uncontrolled seizures and epilepsy-related morbidity and mortality. We evaluated rates of post-VNS surgical re-evaluation and epilepsy surgery among pediatric VNS non-responders and secondarily assessed seizure and antiseizure medication (ASM) outcomes.

METHODS

We performed a retrospective review of pediatric patients with DRE who underwent VNS implantation at our institution (2013-2020). Patients were classified as "responders" if they achieved ≥ 50% seizure frequency reduction from baseline. Variables included demographics, operating surgeon, generator model, revision history, seizure type and frequency, and ASM burden. Groups were compared using chi-square and Student's T-tests.

RESULTS

Forty-seven patients (25 responders, 22 non-responders) met inclusion criteria. Groups did not differ significantly in age, sex, race, operating surgeon, generator model, revision history, or baseline ASM burden. At follow-up, responders required fewer ASMs than non-responders (p = 0.03). Among non-responders, only 3/22 patients (13.6%) underwent additional epilepsy surgery (two responsive neurostimulation, one corpus callosotomy), and all achieved meaningful seizure reduction postoperatively. Three deaths occurred in the non-responder group, none surgery-related.

CONCLUSION

Nearly half of pediatric patients treated with VNS failed to achieve seizure reduction, yet few underwent re-evaluation for further surgical management despite favorable outcomes among those who did. Structured follow-up pathways are needed to ensure timely surgical re-assessment of pediatric VNS non-responders within comprehensive epilepsy programs.