Work

Effects of vagus nerve stimulation and epilepsy surgery on antiseizure medication usage in pediatric patients with drug‐resistant epilepsy in the real world: A retrospective nationwide cohort study

Year: 2025

Type: article

Abstract: OBJECTIVE: The long-term effects of epilepsy surgery (ES) or vagus nerve stimulation (VNS) on antiseizure medication (ASM) usage and status epilepticus (SE) diagnosis in real-world pediatric drug-resistant epilepsy (DRE) populations remain unclear. This study aimed to provide a more comprehensive understanding of how VNS and ES affect ASM usage and SE manifestations in pediatric DRE. METHODS: We conducted a nationwide, retrospective cohort study using the Korean Health Insurance Review and Assessment Service database from January 1, 2007, to December 31, 2022. Pediatric patients (<18 years) diagnosed with DRE were categorized into ASM-only, VNS, and ES groups. Changes in ASM usage and SE diagnostic rates were assessed. RESULTS: A total of 6075 pediatric patients with DRE were included (ASM-only, n = 5407; VNS, n = 217; ES, n = 451). Although the VNS and ES groups had more severe epilepsy at baseline, both interventions significantly reduced ASM usage, albeit with distinct trajectories. ES led to a sharp reduction in ASM usage immediately postoperatively, followed by stabilization, with approximately one-third of the patients discontinuing ASM by the end of follow-up. VNS stabilized ASM usage rather than reducing it, with fewer than 10% of patients discontinuing ASM. Both interventions were associated with significant decreases in SE diagnostic rates after the intervention (p = 0.007 and 0.02, respectively), but no statistically significant difference was found in the overall SE rates among the three groups (p = 0.18). SIGNIFICANCE: These findings demonstrate that VNS and CES positively impact ASM usage, reduce the incidence of SE, and underscore the need for timely intervention to optimize outcomes. PLAIN LANGUAGE SUMMARY: We studied children with drug-resistant epilepsy who were treated with either vagus nerve stimulation (VNS) or brain surgery for epilepsy. We found that brain surgery often led to a large and lasting reduction in seizure medication, whereas VNS helped stabilize medication use. Both treatments were linked to fewer cases of status epilepticus, a severe type of seizure emergency. These findings suggest that VNS and surgery may help reduce medication burden and protect against serious seizures in children with hard-to-treat epilepsy.

Source: Epilepsia Open

DOI: 10.1002/epi4.70202

Authors: Jooyoung Lee, Arum Choi, Sukil Kim, Tae‐Hoon Eom

Institutions: The Catholic University of Korea Eunpyeong St. Mary's Hospital, Catholic University of Korea

Language: English

Topic: Epilepsy research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,120