Abstract Details

Title Efficiency and Safety of Vagus Nerve Stimulation in Intractable Epilepsy: An Updated Systematic Review and Meta-analysis

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P7 - Poster Session 7 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-014

Objective

To evaluate the current evidence regarding the Efficiency and safety of Vagus Nerve Stimulation (VNS) in the management of intractable epilepsy.

Background Epilepsy and seizures affect around 1% of the population. They are treated primarily with antiepileptic drugs (AEDs). Yet, around one-third of patients with seizures are unresponsive to medical treatment which indicates a need for effective alternatives such as Vagus Nerve Stimulation (VNS).

Design/Methods We conducted a comprehensive search of electronic databases including PubMed, Ovid Medline, SCOPUS, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) for studies published from inception to August 2023. Only randomized controlled trials (RCTs) of class 1 evidence were included. Data on seizure frequency, treatment response, and adverse events were extracted. We performed meta-analyses using fixed-effect models to estimate the pooled outcomes.

Results Our search yielded a total of 8 studies, encompassing 724 patients. Meta-analysis demonstrated that high-frequency VNS significantly reduced seizure frequency (mean difference = -13.23, 95% CI = -20.15, -6.30, p = .0002) and improved treatment response (risk ratio = 1.95, 95% CI = 1.40, 2.73, p <.0001) compared to low-frequency VNS. This significance persisted for the subgroup analyses of the VNS modality of both outcomes and after removing studies contributing to significant heterogeneity. Adverse events were reported in 8 studies, with no increase in major side effects or mortality in the high-frequency VNS group compared to low-frequency VNS group. The most common complications were hoarseness, throat pain, and coughing, but these were generally transient and tolerable.

Conclusions This updated meta-analysis reaffirms that VNS, particularly high-frequency VNS, is an effective and safe treatment modality for intractable epilepsy, contributing to significant reductions in seizure frequency and enhanced treatment responses advocating for its broader consideration in the management of drug-resistant epilepsy. Further research is warranted to explore mechanisms optimizing VNS parameters for individual patients

Authors/Disclosures
Hadeer Elsaeed AboElfarh, MD (Mansoura Faculty of Medicine) PRESENTER	Dr. AboElfarh has nothing to disclose.
Mariam Abdelhady (October 6 University, Faculty of Medicine)	Ms. Abdelhady has nothing to disclose.
Mohamed S. Shehata, MBBS (Nasr City Insurance Hospital)	Dr. Shehata has nothing to disclose.
Ibraheem Alkhawaldeh	Ibraheem Alkhawaldeh has nothing to disclose.
Maickel K. AbdelMeseh, MBBS	Dr. AbdelMeseh has nothing to disclose.
Mohamed Hany	No disclosure on file

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