Abstract Objective To evaluate clinical outcomes, treatment response and predictors of seizure freedom after vagus nerve stimulation in patients with drug‐resistant epilepsy in a Mexican cohort. Methods We conducted a retrospective multicenter cohort across 13 epilepsy centers in Mexico (2003–2024) including patients aged ≥4 years with drug‐resistant epilepsy or epileptic encephalopathy. Treatment response was defined as at least 50% seizure reduction and Engel outcomes. Logistic regression identified predictors of seizure freedom. Model performance was assessed with receiver operating characteristic analysis, area under the curve, Hosmer–Lemeshow test, and a confusion matrix. Results Ninety‐three patients (51 children, 42 adults) were included. At 1 year, median monthly seizure frequency decreased by 82.5% (40–7; p < .001). The incidence of status epilepticus declined by 92.8%, acute prolonged seizures by 80.9%, the burden of antiseizure medications by 25%, and epilepsy‐related hospitalizations by 100% (all p < .001). Overall, 68.8% achieved ≥50% reduction and 11.8% became seizure‐free. On univariate analysis, comorbidities, multiple seizure types, higher baseline seizure frequency, greater number of antiseizure medications, and magnet use were inversely related to seizure freedom, while normal brain MRI showed a direct relationship. On multivariable analysis, only baseline seizure frequency ≥30/month independently predicted seizure freedom ( p = .047), corresponding to 97.7% lower odds. A predictive model incorporating comorbidities and number of antiseizure medications improved discrimination ( p < .001) with 86.6% sensitivity and 81.8% specificity. Significance Vagus nerve stimulation was associated with substantial seizure frequency reduction, lower morbidity, and less healthcare utilization, with a favorable safety profile. Baseline seizure burden emerged as the key predictor of seizure freedom and may guide patient selection, supporting earlier vagus nerve stimulation consideration in drug‐resistant epilepsy.
Castelo-Pablos et al. (2026) studied this question.