Systematic Review and Meta-Analysis of Bilateral Centromedian Nucleus Neuromodulation for Multifocal and Generalized Epilepsy.

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation Pub Date : 2025-06-10 DOI:10.1016/j.neurom.2025.04.008

Ahmad Alhourani, Ling-Ya Chao, Edward F Chang, Vikram R Rao

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引用次数: 0

Abstract

Objectives: Generalized and multifocal forms of drug-resistant epilepsy are highly prevalent but have limited treatment options. Centromedian nucleus (CMN) thalamic neuromodulation has emerged as an effective treatment for these epilepsies, but head-to-head neuromodulation modality trials do not exist, and optimal stimulation parameters are not established.

Materials and methods: Using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a systematic review by searching PubMed and Embase for peer-reviewed studies of bilateral CMN deep brain stimulation (DBS) or responsive neurostimulation (RNS) for generalized and/or multifocal epilepsy. From studies that met the inclusion criteria, we extracted individual patient data and used a mixed-effects model to compare seizure frequency reduction (SR) of modalities and for DBS, across different stimulation frequencies.

Results: A total of 25 studies with 192 total patients were included. DBS and RNS yielded comparable SR (76.8% vs 66.7%, respectively, p = 0.1). Within the DBS cohort, high-frequency (>100 Hz) stimulation was more effective for SR by 20.16% (CI: 6.49-33.83) than low-frequency stimulation. Patients with Lennox-Gastaut Syndrome (LGS) had 13.37% lower SR (CI: -26.17 to -0.56) than did those without this diagnosis. Longer follow-up duration (≥18 months) was associated with 12.60% greater SR (CI: 2.53-22.68).

Conclusions: For CMN thalamic neuromodulation in patients with multifocal or generalized epilepsy, modality type (RNS vs DBS) may matter less for SR than may underlying diagnosis (LGS vs not LGS), stimulation parameters (high- vs low-frequency), and treatment duration. These findings have implications for the therapeutic mechanism(s) of thalamic neuromodulation and motivate further study of optimal stimulation approaches.

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双侧中央核神经调节治疗多灶性和广泛性癫痫的系统评价和荟萃分析。

目的：全身性和多灶性耐药癫痫非常普遍，但治疗选择有限。中心核（CMN）丘脑神经调节已成为治疗这些癫痫的有效方法，但没有头对头神经调节方式的试验，也没有建立最佳刺激参数。材料和方法：使用系统评价和荟萃分析指南的首选报告项目，我们通过检索PubMed和Embase，对双侧CMN深部脑刺激（DBS）或反应性神经刺激（RNS）治疗全面性和/或多灶性癫痫的同行评审研究进行了系统评价。从符合纳入标准的研究中，我们提取了个体患者数据，并使用混合效应模型来比较不同刺激频率下模式和DBS的癫痫发作频率降低（SR）。结果：共纳入25项研究，192例患者。DBS和RNS的SR相当（分别为76.8%和66.7%,p = 0.1）。在DBS队列中，高频（bb0 - 100 Hz）刺激对SR的效果比低频刺激高20.16% （CI: 6.49-33.83）。lenox - gastaut综合征（LGS）患者的SR比无此诊断的患者低13.37% （CI: -26.17至-0.56）。较长的随访时间（≥18个月）与12.60%的高SR相关（CI: 2.53-22.68）。结论：对于多灶性或广泛性癫痫患者的CMN丘脑神经调节，模式类型（RNS vs DBS）对SR的影响可能小于潜在诊断（LGS vs非LGS）、刺激参数（高频vs低频）和治疗时间。这些发现对丘脑神经调节的治疗机制具有启示意义，并激发了对最佳刺激方法的进一步研究。

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来源期刊

Neuromodulation 医学-临床神经学

CiteScore

6.40

自引率

3.60%

发文量

978

审稿时长

54 days

期刊介绍： Neuromodulation: Technology at the Neural Interface is the preeminent journal in the area of neuromodulation, providing our readership with the state of the art clinical, translational, and basic science research in the field. For clinicians, engineers, scientists and members of the biotechnology industry alike, Neuromodulation provides timely and rigorously peer-reviewed articles on the technology, science, and clinical application of devices that interface with the nervous system to treat disease and improve function.