Vagus nerve stimulation for drug‐resistant epilepsy and predictors for seizure freedom: A nationwide multicenter cohort study in Mexico
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To evaluate clinical outcomes, treatment response and predictors of seizure freedom after vagus nerve stimulation in patients with drug-resistant epilepsy in a Mexican cohort. METHODS: We conducted a retrospective multicenter cohort across 13 epilepsy centers in Mexico (2003-2024) including patients aged ≥4 years with drug-resistant epilepsy or epileptic encephalopathy. Treatment response was defined as at least 50% seizure reduction and Engel outcomes. Logistic regression identified predictors of seizure freedom. Model performance was assessed with receiver operating characteristic analysis, area under the curve, Hosmer-Lemeshow test, and a confusion matrix. RESULTS: Ninety-three patients (51 children, 42 adults) were included. At 1 year, median monthly seizure frequency decreased by 82.5% (40-7; p < .001). The incidence of status epilepticus declined by 92.8%, acute prolonged seizures by 80.9%, the burden of antiseizure medications by 25%, and epilepsy-related hospitalizations by 100% (all p < .001). Overall, 68.8% achieved ≥50% reduction and 11.8% became seizure-free. On univariate analysis, comorbidities, multiple seizure types, higher baseline seizure frequency, greater number of antiseizure medications, and magnet use were inversely related to seizure freedom, while normal brain MRI showed a direct relationship. On multivariable analysis, only baseline seizure frequency ≥30/month independently predicted seizure freedom (p = .047), corresponding to 97.7% lower odds. A predictive model incorporating comorbidities and number of antiseizure medications improved discrimination (p < .001) with 86.6% sensitivity and 81.8% specificity. SIGNIFICANCE: Vagus nerve stimulation was associated with substantial seizure frequency reduction, lower morbidity, and less healthcare utilization, with a favorable safety profile. Baseline seizure burden emerged as the key predictor of seizure freedom and may guide patient selection, supporting earlier vagus nerve stimulation consideration in drug-resistant epilepsy.
Source: Epileptic Disorders
DOI: 10.1002/epd2.70202
Authors: María F. Castelo‐Pablos, Alma M. Huerta‐Hurtado, Immer Armendáriz‐Betancourt, Noel Plascencia‐Álvarez, Elma Paredes‐Aragón, Sonia I. Mejía‐Pérez, José A. Infante‐Cantú, Horacio Sentíes‐Madrid, María I. Alanís‐Guevara, Araceli Reyes‐Cuayahuitl, Mario A. Alonso‐Vanegas, Diego A. Barrera‐Tovar, Avril Molina‐García, Manuel C. Porras‐Betancourt, Matilde Ruiz‐Garcia, Giovanny Soca‐Chafre, Irene Gómez‐Oropeza, Roberto A. Lugo‐Guillén, Samuel Pérez‐Cardenas, Denisse Romero‐García, Juan C. Reséndiz‐Aparicio
Institutions: Instituto Nacional de Neurología y Neurocirugía, Mexican Social Security Institute, Institute for Social Security and Services for State Workers, Hospital Zambrano Hellion, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Centro Medico Nacional Siglo XXI, Hospital General de México, Instituto Nacional de Pediatria, Hospital Infantil de México Federico Gómez, Universidad Nacional Autónoma de México
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W7128906121