Vagus nerve stimulation and fast parameter programming protocol in children with febrile infection-related epilepsy syndrome in ICU

Tinghong Liu; Zheng Li; Jinshan Xu; Lijuan Wang; Chunhong Chen; Feng Zhai; Jian Ji; Yangshuo Wang; Feng Chen; Bowen Yu; Quan Wang; Shuli Liang

doi:10.1016/j.neurot.2025.e00551

Vagus nerve stimulation and fast parameter programming protocol in children with febrile infection-related epilepsy syndrome in ICU

Neurotherapeutics. 2025 Apr;22(3):e00551. doi: 10.1016/j.neurot.2025.e00551. Epub 2025 Feb 25.

Authors

Tinghong Liu¹, Zheng Li², Jinshan Xu³, Lijuan Wang⁴, Chunhong Chen⁵, Feng Zhai⁶, Jian Ji⁷, Yangshuo Wang⁸, Feng Chen⁹, Bowen Yu¹⁰, Quan Wang¹¹, Shuli Liang¹²

Affiliations

¹ Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: liutinghong1@163.com.
² Pediatric Intensive Care Unit, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China. Electronic address: tim49775512@hotmail.com.
³ Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: goldmount@163.com.
⁴ Pediatric Intensive Care Unit, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China. Electronic address: wanglijuandexin@126.com.
⁵ Neurology Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China. Electronic address: sjkbch@sina.com.
⁶ Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: zhaifengyh5288@163.com.
⁷ Pediatric Intensive Care Unit, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China. Electronic address: jijian8875@sina.com.
⁸ Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: wysh1227@163.com.
⁹ Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: c198888f@126.com.
¹⁰ Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: yubowen301@163.com.
¹¹ Pediatric Intensive Care Unit, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China. Electronic address: wangquan@bch.com.cn.
¹² Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China. Electronic address: liangshuli@bch.com.cn.

Abstract

In the acute phase of Febrile infection-related epilepsy syndrome (FIRES), super-refractory status epilepticus (SE) is a common clinical symptom. This research aimed to study effectiveness of vagus nerve stimulation (VNS) and explore a rapid parameter programming protocol suitable for VNS in patients with the acute phase of FIRES-related super-refractory SE. The children with acute phase of FIRES-related prolonged super-refractory SE in ICU were enrolled and divided into VNS and control group based on whether the patient underwent VNS. A standardized rapid programming protocol of stimulation parameters was used in patients with VNS. The patients' demographic data, treatments method, time of SE termination, percentage of seizure freedom, mortality, activities of daily living, and Glasgow Outcome Scale (GOS) were collected and analyzed. Sixty patients were enrolled, and 30 in VNS group underwent VNS with rapid parameter programming protocol. A significant difference was found in their duration of SE after enrollment between groups. VNS was the exclusive influence factor for post-enrollment mortality of all patients and seizure freedom in surviving patients. Patients without VNS presented a significantly higher probability of death (HR = 3.46) and recurrent seizures (HR = 7.75) compared to those with VNS. A significant difference was also observed in the percentage of patients with ADL scores >60 between the two groups at follow-up. No obvious complication was reported for the surgery of VNS and during the electrical stimulation process. VNS with rapid parameters programming protocol was a safe approach for treating super-refractory SE in the acute phase of FIRES. It can significantly reduced the duration of SE, mortality, and recurrent seizure.

Keywords: Febrile infection-related epilepsy syndrome (FIRES); Mortality; Seizure freedom; Super-refractory status epilepticus; Vagus nerve stimulation (VNS).

MeSH terms

Child
Child, Preschool
Drug Resistant Epilepsy / therapy
Female
Humans
Infant
Intensive Care Units*
Male
Status Epilepticus* / etiology
Status Epilepticus* / therapy
Treatment Outcome
Vagus Nerve Stimulation* / methods