Vagus nerve stimulation in pediatric patients with Lennox-Gastaut syndrome: a systematic review.
BACKGROUND This study evaluates the efficacy and safety of Vagus Nerve Stimulation (VNS) in the treatment of refractory Lennox-Gastaut Syndrome (LGS) in pediatric patients. METHODS A systematic literature review was conducted based on observational studies and case series analyses, followed by assessment of risk of bias using the ROBINS-I tool. RESULTS The results demonstrated that, among the combined sample of 527 patients included in the selected studies, 375 achieved a reduction greater than 50% in seizure frequency after VNS therapy, with some cases reporting complete seizure remission. The analysis suggests greater effectiveness for atonic seizures (drop attacks), followed by tonic and absence seizures. Regarding secondary outcomes, significant qualitative improvements were reported in alertness, attention, and sleep quality. Although the intervention appears to be relatively safe, the included studies presented a high risk of bias in the outcome measurement domain, mainly due to the impracticality of blinding in surgical procedures and the subjective nature of caregiver-reported outcomes. The heterogeneity of clinical responses appears to be associated with differences in stimulation parameters and variability in baseline clinical conditions. CONCLUSION VNS yields results that suggest potential utility in the management of LGS. While the ideal scenario would require randomized clinical trials with representative and exclusive samples for the syndrome, as well as standardized stimulation protocols, it is understood that methodological limitations exist when dealing with a rare syndrome. Therefore, the importance of this systematic review is highlighted in order to encourage individualized and assertive clinical decisions in the management of these patients.