Evaluate the time to treatment with VNS.

People with DRE navigate a care journey that involves trials of multiple pharmaceutical, dietary, and surgical interventions. Seizure management can occur via primary care physicians; however, delayed referral to Comprehensive Epilepsy Centers (CECs) may result in delayed access to advanced epilepsy management techniques (e.g., surgery or neuromodulation).

Patients receiving an initial VNS or battery replacement were enrolled into the prospective, multicenter observational registry (CORE-VNS, NCT03529045) which aimed to collect a wide range of outcomes data on patients with VNS. Participants will be followed for up to 36 months. Participants were grouped into subpopulations: all individuals undergoing initial implant, first implant <5 years from epilepsy diagnosis, and first implant >5 years from epilepsy diagnosis.

CORE-VNS enrolled 529 participants (> 18 years = 54.6%, median age at implant =24.43 years) seeking initial implant with VNS. Participants were geographically and ethnically diverse, with 42.7% European, 30.1% from the Americas, and 22.9% from the Western Pacific. Median age of epilepsy diagnosis was 6 years. Of participants receiving their first VNS device, 115 were implanted less than 5 years from epilepsy diagnosis. 84.1% had no prior brain surgery. Patients who waited longer for VNS were more likely to have had epilepsy surgery prior (18.6% vs 6.1%). At the most recent follow-up of the full cohort data (12 months data), 65.7% of all first implanted patients were responsive to therapy (≥50% reduction in seizure frequency) and had reduced their ASM load by an average of 10.99%. There was a marginally greater likelihood to respond to therapy when implanted earlier (71.3% vs 64.1%).

VNS is effective in highly refractory patients with 2 in 3 patients experiencing meaningful reduction in seizure frequency by 12 months. Interim data suggest care for people with DRE may be improved by more efficient referrals.