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Vagus nerve stimulation: a 20-year Australian experience

  • Original Article - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

Background

Vagus nerve stimulation (VNS) therapy was first approved in the mid-1990s in the USA, Europe and Australia, with demonstrable efficacy in paediatric populations. Benefit in seizure frequency reduction can be observed up to 2 years post-intervention; however, few studies assess outcomes beyond this period. Furthermore, paediatric cohort sizes are small, limiting generalisability of outcome assessments. We evaluate VNS insertion outcomes and complications or side-effects in a large paediatric cohort, over a 20-year period from Queensland’s first VNS insertion.

Methods

A retrospective review was conducted of all paediatric VNS insertions at the Queensland Children’s Hospital (QCH) and the Mater Children’s Hospital/Mater Children’s Private Hospital (MCH/MCPH) Brisbane. A minimum of 1-year follow-up from 1999 to 2020 was required for inclusion. Patients were assessed on demographics, epilepsy details, seizure outcomes and complications or side-effects.

Results

In this extended follow-up cohort (76 patients, 7.2 ± 5.3 years), 51.3% of patients had ≥ 50% seizure frequency reduction, while 73.7% experienced an Engel III outcome (worthwhile benefit) or better. Eleven patients (14.9%) were seizure-free at follow-up, and 81.6% retained long-term therapy. Stimulation-related side-effects are common (17.1%) but rarely result in stimulation cessation (3.9%). Cessation occurred in 14 patients (18.4%) and most commonly related to minimal benefit (13.2%). Demographics, aetiology, seizure nature and surgical factors did not influence outcomes.

Conclusion

Over extended treatment periods, a large proportion of patients will benefit significantly from VNS therapy. Approximately 4 of 5 patients will retain VNS therapy, and in cases of cessation, this is most commonly related to minimal benefit. Underlying demographics, aetiology or seizure nature do not influence outcomes. This 20-year Queensland assessment of VNS therapy outcomes informs long-term expectation of VNS therapy.

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Authors and Affiliations

  1. Department of Neurosurgery, Queensland Children’s Hospital, Brisbane, QLD, Australia

    Charles F. Yates, Liam G. Coulthard, Robert Campbell & Martin Wood

  2. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Charles F. Yates & Liam G. Coulthard

  3. School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Charles F. Yates, Kate Riney, Stephen Malone, Ubaid Shah, Liam G. Coulthard & Robert Campbell

  4. Neurosciences Unit, Queensland Children’s Hospital, Brisbane, QLD, Australia

    Kate Riney, Stephen Malone, Ubaid Shah & Geoff Wallace

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  1. Charles F. Yates
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Correspondence to Charles F. Yates.

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Yates, C.F., Riney, K., Malone, S. et al. Vagus nerve stimulation: a 20-year Australian experience. Acta Neurochir 164, 219–227 (2022). https://doi.org/10.1007/s00701-021-05046-0

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