Neurostimulation in generalized epilepsy: A systematic review and meta-analysis

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Generalized epilepsy treatment involves vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS).
• Lack of head-to-head comparisons makes device selection challenging.
• This meta-analysis systematically compares neurostimulation outcomes in generalized epilepsy.

Approach:

• A systematic review and meta-analysis followed PRISMA guidelines.
• Searched PubMed, Embase, and Web of Science for studies on VNS, DBS, and RNS in drug-resistant generalized epilepsy up to August 2022.
• Pooled data from 20 studies using a random-effects model.

Key Points:

• Meta-analysis included 7 studies for VNS (n=510) and 9 for DBS (n=87).
• Data for RNS (5 studies, n=18) were insufficient for meta-analysis.
• VNS achieved a 48.3% seizure reduction, while DBS achieved 64.8% (p=0.02).

Conclusions:

• Deep brain stimulation (DBS) may offer superior seizure reduction compared to vagus nerve stimulation (VNS) in generalized epilepsy.
• Responsive neurostimulation (RNS) shows promise, but requires further investigation.
• This comparative analysis aids in understanding neurostimulation device efficacy for generalized epilepsy.