Significant reduction of seizure frequency in patients with drug-resistant epilepsy by vagus nerve stimulation: Systematic review and meta-analysis.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2025-01-09 DOI:10.1016/j.eplepsyres.2025.107510

Malaisamy Muniyandi, Karthick Chelvanayagam, Sahil Abdul Salam, Sathishkumar Vadamalai, Kavitha Rajsekar, Rajeswari Ramachandran

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引用次数: 0

Abstract

Background: Epilepsy is a major neurological disorder, typically managed with Anti-Seizure Medication (ASM). Nevertheless, a substantial 30 % of patients did not respond satisfactorily to ASMs, classifying their condition as Drug-Resistant Epilepsy (DRE). Vagus Nerve Stimulation (VNS) was recommended as a potential solution.

Objective: To evaluate clinical efficacy of VNS on patients with DRE in reduction of seizures through a systematic review and meta-analysis using a random effects model.

Methods: A systematic search was done from PubMed, ScienceDirect, Cochrane Library and Google Scholar databases on observational studies and randomized controlled trials (RCTs) for the clinical effectiveness of VNS among DRE patients. A meta-analysis was performed to obtain the pooled estimate of the clinical effectiveness of VNS in terms of seizure reduction and the odds ratio (OR) for patients achieving > 50 % seizure reduction. Heterogeneity was assessed using visual inspection of forest plots and I² statistic.

Results: A total of 1023 articles were retrieved from the electronic search. After removing duplicates, non-relevance and non-availability of efficacy data, 28 articles were included in the final analysis. Of these, 9 are RCTs and 19 are observational studies. The pooled estimate of > 50 % seizure reduction was 0.46 (95 % CI: 0.40-0.51) and the pooled estimate of the OR comparing > 50 % vs ≤ 50 % seizure reduction was 0.76 (95 % CI: 0.44-1.29).

Conclusion: Our meta-analysis showed that 46 % of DRE patients have experienced ≥ 50 % seizure reduction with VNS treatment. It should be considered in patients in whom ASM has failed or who continue to experience seizures after medication.

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迷走神经刺激对耐药癫痫患者癫痫发作频率的显著降低：系统回顾和荟萃分析。

背景：癫痫是一种主要的神经系统疾病，通常使用抗癫痫药物（ASM）进行治疗。然而，高达30% %的患者对抗痉挛药物反应不满意，将其归类为耐药癫痫（Drug-Resistant Epilepsy， DRE）。迷走神经刺激（VNS）被推荐为潜在的解决方案。目的：采用随机效应模型，通过系统评价和meta分析，评价VNS对DRE患者减少癫痫发作的临床疗效。方法：系统检索PubMed、ScienceDirect、Cochrane Library和b谷歌Scholar数据库的观察性研究和随机对照试验（rct），研究VNS对DRE患者的临床疗效。我们进行了一项荟萃分析，以获得VNS在减少癫痫发作方面的临床有效性的汇总估计，以及达到> 50% %癫痫发作减少的患者的优势比（OR）。采用森林样地目视检验和I2统计量评价异质性。结果：电子检索共检索到文献1023篇。在剔除重复、不相关和不可获得的疗效数据后，28篇文献被纳入最终分析。其中9项为随机对照试验，19项为观察性研究。> 50 %与≤ 50 %癫痫发作减少的合并估计为0.46(95 % CI: 0.40-0.51), > 50 %与≤ 50 %癫痫发作减少的合并估计OR为0.76（95 % CI: 0.44-1.29）。结论：我们的荟萃分析显示，46% %的DRE患者在VNS治疗后癫痫发作减少≥ 50% %。对于ASM失败或服药后仍有癫痫发作的患者，应考虑使用它。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.