title: Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the guideline development subcommittee of the american academy of neurology.
abstract: OBJECTIVE
  To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years.
  
  
  METHODS
  We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology.
  
  
  RESULTS
  VNS is associated with a >50% seizure reduction in 55% (95% confidence interval [CI] 50%-59%) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50% seizure reduction in 55% (95% CI 46%-64%) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50% seizure frequency reduction rates of ~7% from 1 to 5 years postim-plantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95% CI 1.0-11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time.
  
  
  CONCLUSIONS
  VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation. Neurology® 2013;81:1-7.
authors.affiliation: Aurora Epilepsy Center, St. Luke's Medical Center, Milwaukee, WI.
authors.forename: George L
authors.initials: GL
authors.lastname: Morris
authors.affiliation: Barrow Neurologic Institute, Phoenix, AZ.
authors.forename: David
authors.initials: D
authors.lastname: Gloss
authors.affiliation: University of Calgary, Alberta, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Buchhalter
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mack
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Katherine
authors.initials: K
authors.lastname: Nickels
authors.affiliation: Hofstra University North Shore-Long Island Jewish Medical College, Great Neck, NY.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Harden