VNS for refractory status epilepticus

• A systematic review of VNS for refractory status epilepticus (RSE) was performed.
• 17 articles met the inclusion/exclusion criteria, with 28 patients were treated.
• Generalized RSE patients displayed a 76.0% rate of termination of RSE.
• Focal status patients displayed only a 25.0% response rate.
• There is Oxford level 4, GRADE D evidence for the use VNS for generalized RSE.

SummaryBackgroundOur goal was to perform a systematic review of the literature on the insertion of vagal nerve stimulators (VNS) for refractory status epilepticus (RSE) and its impact on the control of RSE.MethodsAll articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to June 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers (FZ and MW).ResultsOverall, 17 studies were identified, with 7 manuscripts and 10 meeting abstracts. A total of 28 patients were treated. In those with generalized RSE, 76% displayed cessation of RSE with VNS insertion. In cases of focal RSE, 25% responded to VNS insertion. Few adverse effects related to VNS insertion were described.ConclusionsWe currently cannot recommend the use of VNS for RSE. Oxford level 4, GRADE D evidence exists to suggest improvement in seizure control with the use of urgent VNS in generalized RSE. No comments can be made on the utility of VNS in focal RSE. Further prospective study is warranted.