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Vagus Nerve Stimulation (VNS) is a well\u2010established treatment for drug\u2010resistant epilepsy (DRE). In this study, we explore the safety and efficacy of VNS for SRSE. A database search was conducted until August 14, 2024 to identify patients who were implanted with a VNS as a surgical neuromodulation therapy for SRSE. We report on the etiology of SRSE, previous DRE diagnosis, VNS parameters required for SRSE resolution, and long\u2010term outcomes. Out of 257 screened studies, 24 met inclusion criteria, encompassing 30 published cases. Alongside 3 institutional cases, our study analyzed 33 patients. VNS was associated with SRSE resolution in 29\/33 patients (87.87%). Median age at surgery was 15\u2009years (range: neonate to 67\u2009years). Seventeen had prior DRE diagnoses. Days on A\u2010T before implantation ranged from 5 to 420 (median 25, IQR 12\u201342.5). Median VNS output for resolution was 1.375 milliamperes (mA) (IQR\u2009=\u20091\u20131.75), with 1\u2009mA being the most common setting (11\/30, 36.6%). Median time to reach therapeutic VNS parameters was 2\u2009days (IQR\u2009=\u20091.25\u20137.75). SRSE resolved at a median of 7\u2009days post\u2010op 7 (IQR: 4.75\u201314). At follow\u2010up of DRE patients, McHugh scores were as follows: 1 (8\/15, 53.3%), 2 (4\/15, 26.6%), 3 (1\/15, 6.6%), and 5 (2\/15, 13.3%). VNS was associated with SRSE resolution in 87.87% of cases. Based on available observational data, VNS may be considered for SRSE after 2\u2009weeks of treatment nonresponse. Proposed titration strategies to reach \u22651\u2009mA include immediate (within 20\u2009min post\u2010op), rapid (within 24\u201336\u2009h), and accelerated (within 2\u2009weeks). Titration should be individualized based on SRSE duration and patient tolerance. Further studies are needed to define the role of VNS in SRSE.<\/jats:p>","DOI":"10.1002\/epd2.70053","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T08:39:43Z","timestamp":1750408783000},"page":"1038-1050","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Optimizing vagus nerve stimulation for Super Refractory Status Epilepticus: A case series and systematic review"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4234-2199","authenticated-orcid":false,"given":"Diego","family":"Pichardo\u2010Rojas","sequence":"first","affiliation":[{"name":"Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda \u201cManuel Velasco Su\u00e1rez\u201d  Ciudad de M\u00e9xico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Janely","family":"Camarena\u2010Rubio","sequence":"additional","affiliation":[{"name":"Instituto Nacional de 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