title: VNS for refractory status epilepticus.
abstract: BACKGROUND
  Our 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.
  
  
  METHODS
  All 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).
  
  
  RESULTS
  Overall, 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.
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada; Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada. Electronic address: umzeiler@cc.umanitoba.ca.
authors.forename: F A
authors.initials: FA
authors.lastname: Zeiler
authors.affiliation: Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada. Electronic address: kaitlinzeiler@gmail.com.
authors.forename: K J
authors.initials: KJ
authors.lastname: Zeiler
authors.affiliation: Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada. Electronic address: jteitelbaum@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Teitelbaum
authors.affiliation: Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada; Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada. Electronic address: ketaminereview@gmail.com.
authors.forename: L M
authors.initials: LM
authors.lastname: Gillman
authors.affiliation: Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada. Electronic address: mwest@exchange.hsc.mb.ca.
authors.forename: M
authors.initials: M
authors.lastname: West
mesh_terms: D006801:Humans; D013226:Status Epilepticus / Q000628:therapy*; D055536:Vagus Nerve Stimulation / Q000379:methods*
keywords: Refractory status epilepticus; Status epilepticus; VNS; Vagal nerve stimulation