Neurostimulation in Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis from the ILAE Evidence-Based Epilepsy Surgery Task Force
Abstract number :
2.103
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1826135
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:52 AM
Authors :
Lahoud Touma, MD - Université de Montréal; Bénédicte Dansereau – Département de Neurosciences, – Université de Montréal, Montréal, QC, CA; Alvin Chan – Department of Neurological Surgery – University of California, Irvine, Orange, CA, USA; Lily Wong-Kisiel – Department of Neurology – Mayo Clinic, Rochester, MN, USA; John Rolston – Departments of Neurosurgery and Biomedical Engineering – University of Utah, Salt Lake City, UT, USA; Daniel Friedman – Department of Neurology – New York University Langone Health, NY, USA; Lara Jehi – Department of Neurology – Cleveland Clinic, Cleveland, OH, USA; Kees Braun – Department of Child Neurology – University Medical Center Utrecht Brain Center, Utrecht, Netherlands; Sumeet Vadera – Department of Neurological Surgery – University of California, Irvine, Orange, CA, USA; Churl-Su Kwon – Department of Neurology – Icahn School of Medicine at Mount Sinai, NY, USA; Nathalie Jetté – Department of Clinical Neurosciences – University of Calgary, Calgary, AB, CA; Dario Englot – Department of Neurological Surgery – Vanderbilt University Medical Center, Nashville, TN, USA; Mark Keezer – School of Public Health – Université de Montréal, Montréal, QC, CA
Rationale: Drug-resistant epilepsy (DRE) accounts for up to one third of individuals with chronic epilepsy followed in specialist settings, leading to an important medical and economic burden on affected individuals and society. Our objective was to conduct a systematic review and meta-analysis of vagus nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS) in the treatment of DRE. We summarize the current evidence on efficacy and tolerability for these neuromodulation modalities.
Methods: The PRISMA standards were adhered to for this systematic review. We searched Ovid Medline, Ovid Embase, and the Cochrane Central Register of Controlled Trials on January 14, 2019 and last updated the search on April 14, 2021, with a search strategy using a combination of MeSH and Emtree headings and free-text keywords. Abstract, full text review and data extraction were done in duplicate. We included all published randomized controlled trials (RCT) and their corresponding open-label extension studies, as well as prospective case series, with samples of at least 20 participants (excluding studies limited to children), reporting the efficacy and tolerability/complications of VNS, RNS or DBS in people with DRE. Our primary outcome was the mean percentage decrease in frequency, as compared to baseline, of all epileptic seizures at last study follow-up. Secondary outcomes included proportion of 50% responders (defined as patients having a decrease in seizure frequency of 50% or more) and proportion with seizure freedom, both at last study follow-up.
Results: Our systematic review identified 30 studies reporting on the use of the three neuromodulation modalities in DRE, six of which were RCTs. At long term follow-up, five observational studies for VNS reported a pooled mean percentage decrease in seizure frequency at last follow-up of 34.7% (95% CI: -5.1, 74.5). The pooled probability across 19 case series of being a 50% responder was 42.7% (95% CI: 35.6, 49.9). In the open-label extension studies for RNS, the median seizure reduction was 53%, 66% and 75% at two, five, and nine years of follow-up, respectively. The proportion of responders at the latest reported follow-up was 72.8% (95% CI: 65.1, 79.3). For DBS, the median reduction was 56%, 65% and 75% at two, five and seven years, respectively. Seizure freedom increased over time in all modalities. Quality of life was improved significantly in all modalities, across a variety of assessment tools. The most common complications included hoarseness, cough and throat pain for VNS and implant site pain, headache, and dysesthesia for DBS and RNS.
Conclusions: Neurostimulation modalities are an effective treatment option for DRE, with improving outcomes over time and few major complications. Although any comparisons between neuromodulation modalities should be made with caution as studies were performed in different eras, long-term data suggest greater seizure reduction with DBS and RNS as compared to VNS.
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy