Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy

Carefully monitor for site infection after VNS implantation, as infection risk is increased relative to adults (odds ratio 3.4).

Consider adjunctive vagus nerve stimulation (VNS) therapy for seizure frequency reduction.

Consider adjunctive VNS therapy for seizure frequency reduction.

Consider improvement in mood as an additional benefit of VNS therapy.

Consider that VNS may have improved efficacy over time, with a 7% increase in ≥50% seizure frequency reduction rates from 1 to 5 years postimplantation.

Counsel patients that VNS magnet activation may be associated with seizure abortion when used at the time of seizure auras.

Counsel patients that seizure abortion with magnet use may be associated with overall response to VNS treatment.

Optimal VNS settings are still unknown; evidence is insufficient to recommend standard stimulation (30 seconds on, 300 seconds off) vs rapid stimulation (7 seconds on, 30 seconds off) to reduce seizure occurrence.