Efficacy and Tolerability of Vagus Nerve Stimulation Therapy (VNS) in Epileptic Patients at Baghdad Teaching Hospital

Background: Vagus nerve stimulation (VNS) is an established adjuvant therapy for patients with drug-resistant epilepsy (DRE) who are not candidates for resective epilepsy surgery. It has been increasingly used in both pediatric and adult populations to reduce seizure burden and improve quality of life. This study reviews the experience with VNS therapy for DRE at Baghdad Teaching Hospital. Patients and Methods: This uncontrolled retrospective study was conducted at the epilepsy clinic of Baghdad Teaching Hospital. Medical records of 71 patients with DRE who underwent VNS implantation between 2015 and January 2023 were reviewed. The cohort included 51 males and 20 females. Collected variables comprised age at implantation, sex, age at seizure onset, duration of follow-up, seizure type, seizure frequency before and after implantation, epilepsy etiology (lesional or non-lesional), VNS stimulation parameters at the last follow-up visit, and reported adverse effects. Data were analyzed descriptively to assess clinical outcomes and tolerability. Results: The age of epilepsy onset was 10 years in 10 patients (14.1%). Seizure types included focal seizures in 13 patients (18.3%), generalized seizures in 10 (14.1%), focal to bilateral tonic-clonic seizures in 20 (28.2%), and multiple seizure types in 28 (39.4%). Overall, 56 patients (78.9%) showed a clinical response to VNS therapy, while 15 (21.1%) were non-responders. Adverse effects were reported in 30 patients (42.3%), with hoarseness of voice being the most common (32.4%), followed by shortness of breath (15.5%). Most side effects were mild and manageable. Conclusion: VNS is a safe, tolerable, and effective adjuvant treatment for patients with drug-resistant epilepsy who are not suitable candidates for surgical intervention. Seizure control tends to improve over time after implantation, and the majority of adverse effects are mild and well tolerated.