Vagus nerve stimulation for treating refractory epilepsy with myoclonic seizures in children

Objective: To assess the efficacy, tolerability, and safety of vagus nerve stimulation (VNS) in pediatric refractory epilepsy with myoclonic seizures. Methods: We conducted a retrospective monocentric study at a pediatric center specializing in myoclonic seizures. This study included 19 children (13 males, 6 females; mean age 5.8 years, range: 2-14 years) who underwent VNS implantation between January 2019 and July 2025. Myoclonic seizures were confirmed by video electroencephalogram (v-EEG). The median number of Anti-seizure Medications (ASMs) at implantation was 3.1 (IQR: 2-4). The mean follow-up duration was 31 months (range: 12-56 months). Results: Patients exhibited various seizure types, including infantile spasms, myoclonic, myoclonic-tonic, generalized tonic-clonic, generalized tonic, and focal seizures. At the last follow-up, 10 patients (52.6%) achieved ≥50% seizure reduction, and 4 (21.1%) attained seizure freedom. The seizure freedom rate was 31.6% for myoclonic seizures. Significance: VNS demonstrates promise as a safe and effective treatment for pediatric refractory epilepsy (PRE). The seizure freedom rate for myoclonic seizures was particularly noteworthy. These findings suggest that VNS should be considered an early intervention to optimize myoclonic seizure control outcomes.