Evaluating the efficacy of transcranial direct current stimulation for refractory epilepsy: A meta-analysis of RCTs and non-RCTs

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2024-10-11 DOI:10.1016/j.eplepsyres.2024.107456

Yuteng Sun , Xian Tang , Ye Li , Chao Gao , Zhiyuan Shen , Xiaosu Guo , Xin Guo , Zibin Wei , Yicun Jia , Mengyi Zheng , Yaxin Zhang , Yuan Xing , Shujuan Tian

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引用次数: 0

Abstract

An increasing number of research indicate that non-invasive neurostimulation techniques, like transcranial direct current stimulation (tDCS), can effectively control refractory epilepsy. While previous meta-analyses have primarily focused on randomized controlled trials (RCTs), this study expands the scope by including both RCTs and non-RCTs to provide a more comprehensive assessment of tDCS efficacy in treating refractory epilepsy. Through a systematic search of "PUBMED, Embase and Cochrane", we sought relevant studies related to the research topic. We utilized the Cochrane Collaboration tool to assess the risk of bias for the RCTs and the Methodological Index for Non-Randomized Studies (MINORS) tool to evaluate the quality of the non-RCTs included in this meta-analysis. In addition, a protocol for this meta-analysis was registered on PROSPERO (CRD42024496837 http://www.crd.york.ac.uk/ PROSPERO). A total of 14 studies, including 8 RCTs and 6 non-RCTs , involving 307 subjects with refractory epilepsy, were included in this meta-analysis. The combined analysis of RCTs and non-RCTs indicated that tDCS was effective in reducing seizure frequency (SF) in refractory epilepsy patients, with significant improvements observed both four weeks (MD = −4.54; p ＜ 0.01; 95 % CI = −5.69 to −3.38) and eight weeks (MD = −3.49; p ＜ 0.01; 95 % CI = −5.37 to −1.61) after stimulation.

There were no statistically significant differences in Interictal Epileptiform Discharges (IEDs) shortly after stimulation (MD = −3.59; p = 0.42; 95 % CI = −12.33–5.16). However, a reduction was observed at four weeks (MD = −5.28; p ＜ 0.01; 95 % CI = −6.88 to −3.68) and eight weeks post-stimulation (MD = −3.37; p ＜ 0.01; 95 % CI = −5.35 to −1.40). The patient's adverse reactions were mild, and they could be relieved shortly after discontinuation of the stimulus. The quality of evidence across outcomes was assessed as moderate. The results indicate that tDCS demonstrates promising efficacy and safety in managing seizures in refractory epilepsy. While this meta-analysis provides valuable findings, additional large-scale randomized controlled trials are needed to further confirm the efficacy of tDCS for refractory epilepsy.

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评估经颅直流电刺激治疗难治性癫痫的疗效：对研究性试验和非研究性试验的荟萃分析。

越来越多的研究表明，经颅直流电刺激（tDCS）等非侵入性神经刺激技术可以有效控制难治性癫痫。以往的荟萃分析主要关注随机对照试验（RCT），而本研究通过同时纳入随机对照试验和非随机对照试验，扩大了荟萃分析的范围，从而更全面地评估了经颅直流电刺激治疗难治性癫痫的疗效。通过对 "PUBMED、Embase 和 Cochrane "进行系统检索，我们找到了与研究主题相关的研究。我们利用 Cochrane 协作工具评估了 RCT 的偏倚风险，并利用非随机研究方法学指数 (MINORS) 工具评估了纳入本荟萃分析的非 RCT 的质量。此外，本荟萃分析的方案已在 PROSPERO 上注册（CRD42024496837 http://www.crd.york.ac.uk/ PROSPERO）。本次荟萃分析共纳入 14 项研究，包括 8 项研究性临床试验和 6 项非研究性临床试验，涉及 307 名难治性癫痫患者。对研究性临床试验和非研究性临床试验的综合分析表明，tDCS能有效降低难治性癫痫患者的发作频率（SF），刺激后四周（MD = -4.54；p ＜ 0.01；95 % CI = -5.69至-3.38）和八周（MD = -3.49；p ＜ 0.01；95 % CI = -5.37至-1.61）均观察到显著改善。刺激后不久，发作间期癫痫样放电（IEDs）的差异无统计学意义（MD = -3.59；p = 0.42；95 % CI = -12.33-5.16）。然而，在刺激后四周（MD = -5.28；p ＜ 0.01；95 % CI = -6.88 至 -3.68）和八周（MD = -3.37；p ＜ 0.01；95 % CI = -5.35 至 -1.40）观察到了减少。患者的不良反应轻微，在停止刺激后不久即可缓解。所有结果的证据质量均被评为中等。结果表明，tDCS 在控制难治性癫痫发作方面具有良好的疗效和安全性。虽然这项荟萃分析提供了有价值的发现，但还需要更多大规模随机对照试验来进一步证实 tDCS 对难治性癫痫的疗效。

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.