Authors :
Presenting Author: Chun-Lin Kuo, MD, MS – Tri-Service General Hospital, National Defense Medical University
Hung-Yu Lin, MD – Tri-Service General Hospital, National Defense Medical University
Chia-Kuang Tsai, MD, PhD – Tri-Service General Hospital, National Defense Medical University
Fu-Chi Yang, MD, PhD – Tri-Service General Hospital, National Defense Medical University
Jiunn-Tay Lee, MD – Tri-Service General Hospital, National Defense Medical University
Kuan-Yin Tseng, MD, PhD – Tri-Service General Hospital, National Defense Medical University
Yun-Ju Yang, MD – Tri-Service General Hospital, National Defense Medical University
Wei-Hsiu Liu, MD, PhD – Tri-Service General Hospital, National Defense Medical University
Dueng-Yuan Hueng, MD, PhD – Tri-Service General Hospital, National Defense Medical University
Ming-Chen Tsai, MD – Tri-Service General Hospital, National Defense Medical University
Rationale:
Refractory status epilepticus (RSE) is associated with high morbidity and mortality, and there is limited evidence supporting standardized and effective medical treatments. While vagus nerve stimulation (VNS) is an established adjunctive therapy for drug-resistant epilepsy, its role in RSE remains unclear due to small sample sizes and inconsistent outcomes in existing studies.
This systematic review aims to synthesize updated evidence on VNS therapy for RSE, evaluating its efficacy, seizure control, and functional outcomes. Additionally, we collected data on acute parameter settings and titration methods to inform clinical practice.
Methods:
This systematic review, conducted in accordance with the PRISMA 2020 statement, searched PubMed, Embase, CENTRAL, and ClinicalTrials.gov (inception to July 31, 2025) by combining terms for VNS, RSE, New-Onset RSE (NORSE), and Febrile Infection-Related Epilepsy Syndrome (FIRES). Two authors independently screened full-text articles and resolved discrepancies with a third author. We included VNS outcome studies for any RSE in the acute-to-subacute phase (≤ 90 days of onset). We excluded duplications, non-human studies, non-English and non-relevant articles, conference abstracts, and studies on transcutaneous VNS, focal motor SE, electrical status epilepticus in slow-wave sleep, or those lacking a clear VNS response.
Data on demographics, etiologies, prior treatments, and VNS parameters were extracted. VNS titration rates were defined as immediate (< 24h)