Estimulación del nervio vago en el tratamiento de la epilepsia refractaria en niños y adultos.

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Bibliographic Details
Title:	Estimulación del nervio vago en el tratamiento de la epilepsia refractaria en niños y adultos.
Alternate Title:	Vagus nerve stimulation in the treatment of refractory epilepsy in children and adults.
Authors:	Alonso-Vanegas, Mario A.¹ alonsomario@hotmail.com, Huerta-Hurtado, Alma H.², Pérez-Reyes, Sara P.³, Vargas-Ramírez, Guadalupe⁴, Castro-Macías, Jaime I.³, Miranda-González, Alejandro³, Sentíes-Madrid, Horacio⁵
Source:	Revista Mexicana de Neurociencia. 2026 Supplement, Vol. 27, p176-186. 11p.
Subjects:	Vagus nerve stimulation, Treatment effectiveness, Safety, Neural stimulation, Medical protocols, Epilepsy
Abstract (English):	Background: Drug-resistant epilepsy (DRE) affects approximately 30% of patients with epilepsy. Vagus nerve stimulation (VNS) is a neuromodulatory therapy used in patients who are not candidates for resective surgery or who have experienced surgical failure. Objective: To develop an evidence-based clinical practice guideline using the GRADE methodology to evaluate the efficacy, safety, and practical considerations of VNS in patients with DRE. Method: Structured clinical questions were formulated using the PICO framework. A literature review was conducted prioritizing meta-analyses, systematic reviews, and clinical trials. The quality of evidence and strength of recommendations were assessed using the GRADE approach. Results: VNS is associated with a significant reduction in seizure frequency, with responder rates ranging from 40 to 60%. Evidence suggests greater efficacy compared to medical therapy alone in patients who are not candidates for surgery. In Lennox-Gastaut syndrome, corpus callosotomy demonstrates superior efficacy for atonic seizures. High-frequency stimulation is more effective than low-frequency stimulation. The therapeutic effect of VNS increases over time. The therapy has a favorable safety profile, with predominantly mild and reversible adverse effects. Conclusions: VNS is an effective and safe intervention for patients with DRE. Although most recommendations are conditional due to limitations in the quality of evidence, they consistently support the use of VNS in selected clinical scenarios. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Antecedentes: La epilepsia refractaria a fármacos (ERF) afecta aproximadamente al 30% de los pacientes con epilepsia. La estimulación del nervio vago (ENV) es una terapia neuromoduladora utilizada en pacientes no candidatos a cirugía resectiva o con cirugía fallida. Objectivo: Desarrollar una guía clínica basada en evidencia utilizando metodología GRADE para evaluar la eficacia, seguridad y consideraciones prácticas del uso de ENV en ERF. Método: Se formularon preguntas clínicas estructuradas (PICO). Se realizó una revisión de la literatura priorizando metaanálisis, revisiones sistemáticas y ensayos clínicos. La calidad de la evidencia y la fuerza de las recomendaciones se evaluaron mediante metodología GRADE. Resultados: La ENV se asocia con una reducción significativa de crisis, con tasas de respondedores del 40-60%. La evidencia sugiere mayor eficacia frente a tratamiento farmacológico exclusivo en pacientes no candidatos a cirugía. En síndrome de Lennox-Gastaut, la callosotomía muestra mayor eficacia en crisis atónicas. La estimulación de alta frecuencia es más efectiva que la de baja frecuencia. La eficacia de la ENV aumenta con el tiempo. La terapia presenta un perfil de seguridad favorable, con efectos adversos mayormente leves y reversibles. Conclusiones: La ENV es una intervención efectiva y segura en pacientes con ERF. Las recomendaciones son mayoritariamente condicionales debido a la calidad de la evidencia, pero apoyan consistentemente su uso en escenarios clínicos seleccionados. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Background: Drug-resistant epilepsy (DRE) affects approximately 30% of patients with epilepsy. Vagus nerve stimulation (VNS) is a neuromodulatory therapy used in patients who are not candidates for resective surgery or who have experienced surgical failure. Objective: To develop an evidence-based clinical practice guideline using the GRADE methodology to evaluate the efficacy, safety, and practical considerations of VNS in patients with DRE. Method: Structured clinical questions were formulated using the PICO framework. A literature review was conducted prioritizing meta-analyses, systematic reviews, and clinical trials. The quality of evidence and strength of recommendations were assessed using the GRADE approach. Results: VNS is associated with a significant reduction in seizure frequency, with responder rates ranging from 40 to 60%. Evidence suggests greater efficacy compared to medical therapy alone in patients who are not candidates for surgery. In Lennox-Gastaut syndrome, corpus callosotomy demonstrates superior efficacy for atonic seizures. High-frequency stimulation is more effective than low-frequency stimulation. The therapeutic effect of VNS increases over time. The therapy has a favorable safety profile, with predominantly mild and reversible adverse effects. Conclusions: VNS is an effective and safe intervention for patients with DRE. Although most recommendations are conditional due to limitations in the quality of evidence, they consistently support the use of VNS in selected clinical scenarios. [ABSTRACT FROM AUTHOR]
ISSN:	16655044