In people with drug-resistant epilepsy, adjunctive high-stimulation vagus nerve stimulation therapy led to a substantial decrease in seizure frequency without escalating the rate of severe adverse events or discontinuations, when compared with adjunctive low-stimulation vagus nerve stimulation therapy/anti-seizure medications/best medical practice, according to the findings of a systematic review and meta-analysis.

Sarah Batson et al. sought to explore the efficacy and safety of vagus nerve stimulation therapy as an adjunct to anti-seizure medications to mitigate drug-resistant epilepsy. Databases like Cochrane library, Embase, Medline®, and Medline® Epub Ahead of Print were searched to find out the relevant articles. The decline in seizure frequency, seizure freedom, severe adverse events, anti-seizure medications load, and discontinuations were the outcomes ascertained.

The comparators incorporated best medical practice, anti-seizure medications, low-stimulation or sham vagus nerve stimulation therapy. For inclusion, 4 RCTs and 6 comparative observational studies were found. Compared to comparators, people managed with vagus nerve stimulation exhibited remarkably improved odds of experiencing a ≥ 50% decline in seizure frequency (odds ratio: 2.27), a ≥ 75% decline in seizure frequency (odds ratio: 3.56) and a decreased risk for elevated anti-seizure medications load (risk ratio: 0.36).

No difference was noted in the odds of discontinuation or the rate of severe adverse events between the two groups. Thus, vagus nerve stimulation therapy appears to be valuable for people who are not responding to anti-seizure medicines and those not suitable or not willing to undergo surgery.