Clinical outcomes of VNS therapy with AspireSR® (including cardiac-based seizure detection) at a large complex epilepsy and surgery centre

•AspireSR® responds on-demand to ictal tachycardia associated with ∼80% of seizures.•Newly inserted AspireSR® resulted in 59% of patients achieving ≥50% improvement at 13 months.•Battery change to AspireSR® offered 71% of patients ≥50% benefit at mean 21 months.•AutoStim renders VNS therapy independent of patient/caregiver compliance.•AspireSR® VNS therapy could modify patient counseling from the rule of one- thirds. To compare the efficacy of AspireSR® to preceding VNS battery models for battery replacements, and to determine the efficacy of the AspireSR® for new implants. Data were collected retrospectively from patients with epilepsy who had VNS AspireSR® implanted over a three-year period between June 2014 and June 2017 by a single surgeon. Cases were divided into two cohorts, those in whom the VNS was a new insertion, and those in whom the VNS battery was changed from a previous model to AspireSR®. Within each group, the seizure burden was compared between the periods before and after insertion of AspireSR®. Fifty-one patients with a newly inserted AspireSR® VNS model had a significant reduction in seizure frequency (p