Expert consensus on the clinical and organizational use of VNS therapy for drug-resistant epilepsy in the United Arab Emirates: a single-round modified Delphi study.

BACKGROUND

Epilepsy affects over 50 million people worldwide, and approximately one third of patients develop drug-resistant epilepsy (DRE), a major driver of morbidity, mortality, and healthcare costs. Vagus nerve stimulation (VNS) is an established neuromodulatory treatment option for DRE, but local guidance on its use in the United Arab Emirates (UAE) remains limited. This study aimed to establish an expert consensus to define best practices for the effective and efficient use of the VNS in the UAE setting.

METHODS

A multidisciplinary Task Force conducted a literature review and developed 25 evidence- and experience-informed statements, which were refined during an in-person expert meeting to ensure clinical relevance for the UAE context. Statements were rated through a single-round modified Delphi process involving UAE neurologists and neurosurgeons. Participants rated their agreement with each statement using a 7-point Likert scale. Consensus was predefined as ≥ 70% agreement, corresponding to ratings of 6-7. Statements with 60-69% agreement were classified as moderate agreement but were not considered to have reached consensus.

RESULTS

Fifty-six experts completed the Delphi round, corresponding to a 75.7% response rate. Item-level denominators varied across statements. Eighteen of 25 statements reached consensus, six demonstrated moderate agreement, and one did not reach consensus. Strong agreement was observed for patient selection, safety, structured parameter optimization, and multidisciplinary care pathways. Moderate agreement emerged for presurgical evaluation, timing of implantation, and selected clinical scenarios.

CONCLUSION

Building on existing international guidance and previous Delphi work in other settings, this study provides a UAE-specific description of expert agreement and variability on the clinical and organizational use of VNS for DRE. The findings may inform future local pathway development and identify areas requiring clearer definitions, prospective data collection, and further evidence generation.

PLAIN LANGUAGE SUMMARY: This study asked expert clinicians in the United Arab Emirates to rate 25 statements on the clinical and organizational use of vagus nerve stimulation for drug-resistant epilepsy. Vagus nerve stimulation is an adjunctive treatment that aims to reduce seizure burden and improve patient-centred outcomes; it should not be interpreted primarily as a treatment intended to achieve complete seizure freedom. Eighteen statements reached the prespecified consensus threshold, while six showed moderate agreement and one did not reach consensus. Experts showed agreement on several areas, including multidisciplinary care, safety considerations, MRI compatibility, structured follow-up, and individualized programming. However, agreement was more limited for some topics, including expected responder rates after one year, timing of implantation, selected programming criteria, and quality-of-life effects independent of seizure reduction. These findings identify areas where expert views are aligned and areas where practice remains variable. They may support the development of more consistent local care pathways, while highlighting topics that require further clinical evidence and local guidance.