Introduction and objective:
Epilepsy is a brain disorder characterized by a predisposition to induce epileptic seizures. Neurostimulation is one of the therapeutic methods for drug-resistant epilepsy. The choice of therapeutic method is determined by the patient’s condition and an assessment of the benefits and risks of possible side-effects during the use of a particular treatment method. The aim of this review is to provide information on vagus nerve stimulation (VNS) as a therapeutic method for epilepsy.

Review methods:
The review is based on scientific publications in PubMed, Google Scholar, and NCBI databases. The articles were published in English. After the initial evaluation of articles, meta-analyses, case series studies and reviews considering VNS were chosen.

Brief description of the state of knowledge:
VNS is usually considered as a palliative procedure for patients who have unsuccessfully used multiple antiepileptic drugs, and have contraindications to surgical resection of the epileptogenic focus. The device used to stimulate the vagus nerve consists of a pulse generator and a wire with electrodes that are wrapped around the left vagus nerve. About 45–65% of patients respond positively to VNS implantation. However, side-effects include post-operative infection, vocal cord paresis, cough and neck pain, among the others. In addition to VNS, neuromodulation techniques include deep brain stimulation (DBS) and responsive neurostimulation (RNS).

The therapeutic process of epilepsy is a major challenge for doctors. The emergence of new therapeutic methods obliges doctors to update their knowledge of the available methods. The authors of the review emphasize the importance of VNS in the treatment of patients with epileptic seizures. When administered and used correctly, the VNS can be an effective therapeutic solution.

Epilepsy. Bastos F, et al. Handb Clin Neurol. 2020;174:137–158. doi:10.1016/B978-0-444-64148-9.00011-9.
Epilepsy-Definition, Classification, Pathophysiology, and Epidemiology. Falco-Walter J. Semin Neurol. 2020 Dec;40(6):617–623. doi:10.1055/s-0040-1718719.
Fisher RS, Acevedo C, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014 Apr;55(4):475–82. doi:10.1111/epi.12550.
Perucca P, Scheffer IE, et al. The management of epilepsy in children and adults. Med J Aust. 2018;208(5):226–233. doi:10.5694/mja17.00951.
Hakami T. Neuropharmacology of Antiseizure Drugs. Neuropsychopharmacol Rep. 2021;41(3):336–351. doi:10.1002/npr2.12196.
Toffa DH, Touma L, et al. Learnings from 30 years of reported efficacy and safety of vagus nerve stimulation (VNS) for epilepsy treatment: A critical review. Seizure. 2020;83:104–123. doi:10.1016/j.seizure.2020.09.027.
Tsai JD, Fan PC, et al. Vagus nerve stimulation in pediatric patients with failed epilepsy surgery. Acta Neurol Belg. 2021;121(5):1305–1309. doi:10.1007/s13760-020-01303-8.
Abdelmoity AT, Le Pichon JB, et al. Combined use of the ketogenic diet and vagus nerve stimulation in pediatric drug-resistant epilepsy. Epilepsia Open. 2021;6(1):112–119. doi:10.1002/epi4.12453.
Wheless JW, Gienapp AJ, et al. Vagus nerve stimulation (VNS) therapy update. Epilepsy Behav. 2018;88S:2–10. doi:10.1016/j.yebeh.2018.06.032.
LoPresti MA, Huang J, et al. Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series. Childs Nerv Syst. 2023;39(2):435–441. doi:10.1007/s00381-022-05769-0.
Lotan G, Vaiman M. Treatment of epilepsy by stimulation of the vagus nerve from Head-and-Neck surgical point of view. Laryngoscope. 2015;125(6):1352–5. doi:10.1002/lary.25064.
National guideline centre (UK). evidence review: vagus nerve stimulation: epilepsies in children, young people and adults: diagnosis and management: evidence review 14. london: national institute for health and care excellence (NICE). 2022.
Kwan P, Arzimanoglou A, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–77. doi:10.1111/j.1528-1167.2009.02397.x.
Morris GL 3rd, Gloss D, et al. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81(16):1453–9. doi:10.1212/WNL.0b013e3182a393d1.
Pindrik J, Hoang N, Smith L, et al. Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy. Neurosurg Focus. 2018;45(3):E3. doi:10.3171/2018.7.FOCUS18220.
Fernandez L, Gedela S, et al. Vagus nerve stimulation in children less than 3 years with medically intractable epilepsy. Epilepsy Res. 2015;112:37–42. doi:10.1016/j.eplepsyres.2015.02.009.
Strzelczyk A, Schubert-Bast S. Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies. CNS Drugs. 2021;35(1):61–83. doi:10.1007/s40263-020-00784-8.
Thirunavu V, Du R, et al. The role of surgery in the management of Lennox-Gastaut syndrome: A systematic review and meta-analysis of the clinical evidence. Epilepsia. 2021;62(4):888–907. doi:10.1111/epi.16851.
Xiong J, Cao Y, et al. Can we predict response to vagus nerve stimulation in intractable epilepsy. Int J Neurosci. 2020;130(10):1063–1070. doi:10.1080/00207454.2020.1713777.
Vacher E, Rodriguez Ruiz M, et al. Management of brain tumour related epilepsy (BTRE): a narrative review and therapy recommendations. Br J Neurosurg. 2023:1–8. doi:10.1080/02688697.2023.2170326.
Dibué-Adjei M, Fischer I, et al. Efficacy of adjunctive vagus nerve stimulation in patients with Dravet syndrome: A meta-analysis of 68 patients. Seizure. 2017;50:147–152. doi:10.1016/j.seizure.2017.06.007.
Canevini MP, Kotulska-Jozwiak K, et al. Current concepts on epilepsy management in tuberous sclerosis complex. Am J Med Genet C Semin Med Genet. 2018;178(3):299–308. doi:10.1002/ajmg.c.31652.
Wirrell EC, Laux L, et al. Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel. Pediatr Neurol. 2017;68:18–34.e3. doi:10.1016/j.pediatrneurol.2017.01.025.
He Z, Li Y, Zhao X, et al. Dravet syndrome: Advances in etiology, clinical presentation, and treatment. Epilepsy Res. 2022;188:107041. doi:10.1016/j.eplepsyres.2022.107041.
Hajtovic S, LoPresti MA, et al. The role of vagus nerve stimulation in genetic etiologies of drug-resistant epilepsy: a meta-analysis. J Neurosurg Pediatr. 2022;29(6):667–680. doi:10.3171/2022.1.PEDS222.
Canevini MP, Kotulska-Jozwiak K, et al. Current concepts on epilepsy management in tuberous sclerosis complex. Am J Med Genet C Semin Med Genet. 2018;178(3):299–309. doi:10.1002/ajmg.c.31652.
Tomei KL, Mau CY, et al. Vagal nerve stimulation for medically refractory epilepsy in Angelman syndrome: a series of three cases. Childs Nerv Syst. 2018;34(3):395–400. doi:10.1007/s00381-018-3723-z.
Hajnsek S, Petelin Gadze Z, et al. Vagus nerve stimulation in Lafora body disease. Epilepsy Behav Case Rep. 2013;1:150–2. doi:10.1016/j.ebcr.2013.08.002.
Mikati MA, Tabbara F. Managing Lafora body disease with vagal nerve stimulation. Epileptic Disord. 2017;19(1):82–86. doi:10.1684/epd.2017.0892.
Khawaja AM, Pati S, et al. Management of Epilepsy Due to Hypothalamic Hamartomas. Pediatr Neurol. 2017;75:29–42. doi:10.1016/j.pediatrneurol.2017.07.001.
Murphy JV, Wheless JW, et al. Left vagal nerve stimulation in six patients with hypothalamic hamartomas. Pediatr Neurol. 2000;23(2):167–8. doi:10.1016/s0887-8994(00)00170-3.
Parker AP, Polkey CE, et al. Vagal nerve stimulation in the epileptic encephalopathies: 3-year follow-up. Pediatrics. 2001;108(1):221. doi:10.1542/peds.108.1.221.
Wilfong AA, Schultz RJ. Vagus nerve stimulation for treatment of epilepsy in Rett syndrome. Dev Med Child Neurol. 2006;48(8):683–6. doi:10.1017/S00121622060014.
Luo T, Wang Y, et al. Vagus nerve stimulation for super-refractory status epilepticus in febrile infection-related epilepsy syndrome: a pediatric case report and literature review. Childs Nerv Syst. 2022;38(7):1401–1404. doi:10.1007/s00381-021-05410-6.
Englot DJ, Rolston JD, et al. Efficacy of vagus nerve stimulation in posttraumatic versus nontraumatic epilepsy. J Neurosurg. 2012;117(5):970–7. doi:10.3171/2012.8.JNS122.
González HFJ, Yengo-Kahn A, et al. Vagus Nerve Stimulation for the Treatment of Epilepsy. Neurosurg Clin N Am. 2019;30(2):219–230. doi:10.1016/
Yuan H, Silberstein SD. Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part II. Headache. 2016;56(2):259–66. doi:10.1111/head.12650.
Giordano F, Zicca A, et al. Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity. Epilepsia. 2017;58 Suppl 1:85–90. doi:10.1111/epi.13678.
Kaoutzani L, Goldman LV, et al. Revision and removal of vagus nerve stimulation systems: twenty-five years’ experience. Acta Neurochir (Wien). 2023;165(12):3913–3920. doi:10.1007/s00701-023-05875-1.
Broderick L, Tuohy G, et al. Management of vagus nerve stimulation therapy in the peri-operative period: Guidelines from the Association of Anaesthetists: Guidelines from the Association of Anaesthetists. Anaesthesia. 2023;78(6):747–757. doi:10.1111/anae.16012.
von Wrede R, Surges R. Transcutaneous vagus nerve stimulation in the treatment of drug-resistant epilepsy. Auton Neurosci. 2021;235:102840. doi:10.1016/j.autneu.2021.102840.
Shiraishi H, Egawa K, et al. Transcutaneous auricular vagus nerve stimulation therapy in patients with cognitively preserved structural focal epilepsy: A case series report. Brain Dev. 2024;46(1):49–56. doi:10.1016/j.braindev.2023.08.007.
Sarma GRK, Sharma AR, et al. Transcutaneous electrical stimulation of auricular branch of the vagus nerve effectively and rapidly modulates the EEG patterns in patients with possible electrographic status epilepticus. Epileptic Disord. 2023;25(4):500–509. doi:10.1002/epd2.20068.
Batson S, Shankar R, et al. Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis. J Neurol. 2022;269(6):2874–2891. doi:10.1007/s00415-022-10967-6.
Simpson HD, Schulze-Bonhage A, et al. Practical considerations in epilepsy neurostimulation. Epilepsia. 2022;63(10):2445–2460. doi:10.1111/epi.17329.
Touma L, Dansereau B, et al. Neurostimulation in people with drug-resistant epilepsy: Systematic review and meta-analysis from the ILAE Surgical Therapies Commission. Epilepsia. 2022;63(6):1314–1329. doi:10.1111/epi.17243.
Thompson SL, O’Leary GH, et al. A Review of Parameter Settings for Invasive and Non-invasive Vagus Nerve Stimulation (VNS) Applied in Neurological and Psychiatric Disorders. Front Neurosci. 2021;15:709436. doi:10.3389/fnins.2021.709436.
Hampel KG, Vatter H, et al. Cardiac-based vagus nerve stimulation reduced seizure duration in a patient with refractory epilepsy. Seizure. 2015;26:81–5. doi:10.1016/j.seizure.2015.02.004.
Panebianco M, Rigby A, et al. Vagus nerve stimulation for partial seizures. Cochrane Database Syst Rev. 2015;2015(4):CD002896. doi:10.1002/14651858.CD002896.pub2.
Alshehri KA, Abuhulayqah SH, et al. Vagus nerve stimulation in medically refractory epilepsy: Adverse effects and clinical correlates. Neurosciences (Riyadh). 2024;29(1):10–17. doi:10.17712/nsj.2024.1.20230006.
Cukiert A, Cukiert CM, et al. Combined Neuromodulation (Vagus Nerve Stimulation and Deep Brain Stimulation) in Patients With Refractory Generalized Epilepsy: An Observational Study. Neuromodulation. 2023;26(8):1742–1746. doi:10.1016/j.neurom.2022.08.449.
Gouveia FV, Warsi NM, et al. Neurostimulation treatments for epilepsy: Deep brain stimulation, responsive neurostimulation and vagus nerve stimulation. Neurotherapeutics. 2024;21(3):e00308. doi:10.1016/j.neurot.2023.e00308.
Hyslop A, Tatachar P. Neuromodulation for Intractable Childhood Epilepsy. Semin Pediatr Neurol. 2021;39:100918. doi:10.1016/j.spen.2021.100918.
Fisher RS. Deep brain stimulation of thalamus for epilepsy. Neurobiol Dis. 2023;179:106045. doi:10.1016/j.nbd.2023.106045.
Vetkas A, Fomenko A, et al. Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus. Epilepsia. 2022;63(3):513–524. doi:10.1111/epi.17157.
Yan H, Ren L, et al. Deep brain stimulation of the subthalamic nucleus for epilepsy. Acta Neurol Scand. 2022 Dec;146(6):798–804. doi:10.1111/ane.13707.
Bouwens van der Vlis TAM, Schijns OEMG, et al. Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy. Neurosurg Rev. 2019;42(2):287–296. doi:10.1007/s10143-017-0941-x.
Klinger N, Mittal S. Deep brain stimulation for seizure control in drug-resistant epilepsy. Neurosurg Focus. 2018;45(2):E4. doi:10.3171/2018.4.FOCUS1872.
Salanova V. Deep brain stimulation for epilepsy. Epilepsy Behav. 2018;88S:21–24. doi:10.1016/j.yebeh.2018.06.041.
Ma BB, Rao VR. Responsive neurostimulation: Candidates and considerations. Epilepsy Behav. 2018;88:388–395. doi:10.1016/j.yebeh.2018.09.032.
Fan JJ, Shan W, et al. Research progress of vagus nerve stimulation in the treatment of epilepsy. CNS Neurosci Ther. 2019;25(11):1222–1228. doi:10.1111/cns.13209.
Mertens A, Boon P, et al. Neurostimulation for childhood epilepsy. Dev Med Child Neurol. 2023. doi:10.1111/dmcn.15692.
Ghosh S, Sinha JK, et al. A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management. Brain Sci. 2023;13(9):1305. doi:10.3390/brainsci13091305.
Herrman H, Egge A, et al. Anterior thalamic deep brain stimulation in refractory epilepsy: A randomized, double-blinded study. Acta Neurol Scand. 2019;139(3):294–304. doi:10.1111/ane.13047.
Sobstyl M, Stapińska-Syniec A, et al. Deep brain stimulation for the treatment of refractory and super-refractory status epilepticus. Seizure. 2020;81:58–62. doi:10.1016/j.seizure.2020.07.022.
Mallereau CH, Ollivier I, et al. Vagus nerve stimulation in epilepsy: Efficiency and safety of outpatient practice. Neurochirurgie. 2020;66(4):270–274. doi:10.1016/j.neuchi.2020.04.134.
Mao H, Chen Y, et al. Short- and Long-Term Response of Vagus Nerve Stimulation Therapy in Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis. Neuromodulation. 2022;25(3):327–342. doi:10.1111/ner.13509.
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