Vagus nerve stimulation in the treatment of drug-resistant epilepsy: progress and prospects_Journal of Epilepsy

Authors：

Paierhati Tuersun ¹ , Buaxi Maimaitiyiming ² ,  Maimaitijiang Kasimu ¹

1. Department of Functional Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;
2. Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding?author：

Maimaitijiang Kasimu, Email: 13999969488@139.com

Keywords：

Vagus nerve stimulation; Drug-resistant epilepsy; Pediatric epilepsy; Closed-loop stimulation; Stimulation parameters; Long-term prognosis

DOI：

10.7507/2096-0247.202602002

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VNS can achieve a stable reduction in seizure frequency across different DRE populations, with a well-documented time-dependent cumulative therapeutic effect, while complete seizure freedom is rarely achieved in patients. Compared with low-intensity stimulation, high-intensity stimulation significantly increased the probability of achieving ≥50% seizure reduction (RR=1.73). For pediatric DRE, systematic reviews and meta-analyses revealed that approximately 55% of patients achieved significant seizure reduction (≥50%), and the overall response rate reached around 68% in DRE cases with genetic etiologies. Real-world studies indicated that the cumulative rate of ≥12-month complete seizure freedom was approximately 11%, whereas the cumulative rate of ≥12-month freedom from tonic-clonic seizures reached up to 54.9%; moreover, seizure-free status was closely correlated with improved quality of life. In terms of safety profile, common stimulation-related adverse events included voice alteration/hoarseness, cough, and dyspnea, most of which were tolerable. Summaries of long-term clinical experience showed that the incidence of surgery-related complications was approximately 8.6%, and that of hardware-related complications was around 3.7%. Infection, hematoma, vocal cord paralysis, and lead malfunction were the key events requiring priority prevention and control.VNS is an important neuromodulatory treatment option for DRE, especially for patients who are ineligible for resective surgery or have persistent seizures after surgery, with a favorable overall tolerability profile. However, its ability to achieve long-term complete seizure freedom remains limited. Standardized long-term follow-up and individualized programming (including closed-loop strategies and parameter optimization) are expected to further enhance clinical benefits. Future research should focus on stratification by etiology/network phenotype, standardization of core outcome measures, external validation of translatable predictive biomarkers, as well as prospective controlled studies on key programming strategies and combined treatment pathways.

Citation： Paierhati Tuersun, Buaxi Maimaitiyiming, Maimaitijiang Kasimu. Vagus nerve stimulation in the treatment of drug-resistant epilepsy: progress and prospects. Journal of Epilepsy, 2026, 12(2): 143-151. doi: 10.7507/2096-0247.202602002 Copy

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Journal of Epilepsy

Vagus nerve stimulation in the treatment of drug-resistant epilepsy: progress and prospects

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