Neurostimulation in people with drug-resistant epilepsy: Systematic review and meta-analysis from the ILAE Surgical Therapies Commission
Touma, Lahoud; Dansereau, Bénédicte; Chan, Alvin Y.; Jetté, Nathalie; Kwon, Churl Su; Braun, Kees P.J.; Friedman, Daniel; Jehi, Lara; Rolston, John D.; Vadera, Sumeet; Wong-Kisiel, Lily C.; Englot, Dario J.; Keezer, Mark R.
(2022) Epilepsia, volume 63, issue 6, pp. 1314 - 1329
(Article)
Abstract
Objective: Summarize the current evidence on efficacy and tolerability of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) through a systematic review and meta-analysis. Methods: We followed the Preferred Reporting Items of Systematic reviews and Meta-Analyses reporting standards and searched Ovid Medline, Ovid Embase, and the
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Cochrane Central Register of Controlled Trials. We included published randomized controlled trials (RCTs) and their corresponding open-label extension studies, as well as prospective case series, with ≥20 participants (excluding studies limited to children). Our primary outcome was the mean (or median, when unavailable) percentage decrease in frequency, as compared to baseline, of all epileptic seizures at last follow-up. Secondary outcomes included the proportion of treatment responders and proportion with seizure freedom. Results: We identified 30 eligible studies, six of which were RCTs. At long-term follow-up (mean 1.3 years), five observational studies for VNS reported a pooled mean percentage decrease in seizure frequency of 34.7% (95% confidence interval [CI]: −5.1, 74.5). In the open-label extension studies for RNS, the median seizure reduction was 53%, 66%, and 75% at 2, 5, and 9 years of follow-up, respectively. For DBS, the median reduction was 56%, 65%, and 75% at 2, 5, and 7 years, respectively. The proportion of individuals with seizure freedom at last follow-up increased significantly over time for DBS and RNS, whereas a positive trend was observed for VNS. Quality of life was improved in all modalities. The most common complications included hoarseness, and cough and throat pain for VNS and implant site pain, headache, and dysesthesia for DBS and RNS. Significance: Neurostimulation modalities are an effective treatment option for drug-resistant epilepsy, with improving outcomes over time and few major complications. Seizure-reduction rates among the three therapies were similar during the initial blinded phase. Recent long-term follow-up studies are encouraging for RNS and DBS but are lacking for VNS.
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Keywords: deep brain stimulation, drug-resistant epilepsy, neurostimulation, responsive neurostimulation, vagus nerve stimulation, Neurology, Clinical Neurology
ISSN: 0013-9580
Publisher: Wiley-Blackwell
Note: Funding Information: LT, BD, ED, AYC, CSK, KPB, SV, LCW and DJE have nothing to disclose. NJ has received personal compensation for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International League Against Epilepsia (ILAE) . The institution of NJ has received research support from the National Institutes of Health (NIH). The institution of LJ has received research support from the American Epilepsy Society (AES). The institution of NJ has received research support from Patient‐Centered Outcomes Research Institute (PCORI). DF receives salary support for consulting and clinical trial related activities performed on behalf of The Epilepsy Study Consortium, a non‐profit organization. DF receives no personal income for these activities. New York University (NYU) receives a fixed amount from the Epilepsy Study Consortium towards DF’s salary. Within the past 2 years, The Epilepsy Study Consortium received payments for research services performed by DF from: Alterity, Baergic, Biogen, BioXcell, Cerevel, Cerebral, Jannsen, Lundbeck, Neurocrine, SK Life Science, and Xenon. DF has also served as a paid consultant for Neurelis Pharmaceuticals and Receptor Life Sciences. DF has received travel support from the Epilepsy Foundation. He has received research support from National Institute of Neurological Disorders and Stroke (NINDS), Centers for Disease Control and Prevention (CDC), Epitel, and Neuropace unrelated to this study. He serves on the scientific advisory board for Receptor Life Sciences. He holds equity interests in Neuroview Technology. He received royalty income from Oxford University Press. LJ has received personal compensation for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters‐Kluwer. LJ has a non‐compensated relationship as a principal investigator (PI) with that NIH that is relevant to American Academy of Neurology (AAN) interests or activities. JR has received personal compensation for serving as a Consultant for Medtronic. MRK reports unrestricted educational grants from UCB and Eisai, and research grants for investigator‐initiated studies from UCB and Eisai. This report was written by experts selected by the ILAE and was approved for publication by the ILAE. Opinions expressed by the authors, however, do not necessarily represent the policy or position of the ILAE. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Epilepsia Publisher Copyright: © 2022 International League Against Epilepsy.
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