Neuromodulation in Refractory Bitemporal Lobe Epilepsy in Adults: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Neurosurgery
• Medical Engineering

Background:

• Bilateral temporal lobe epilepsy (BTLE) presents a significant challenge in treatment, often proving medically intractable.
• Neuromodulation offers potential therapeutic avenues for patients with refractory epilepsy.

Purpose of the Study:

• To systematically review and meta-analyze the safety and efficacy of Vagus Nerve Stimulation (VNS), Responsive Neurostimulation (RNS), and Deep Brain Stimulation (DBS) for refractory BTLE.
• To compare the seizure reduction rates and complication profiles of these three neuromodulation techniques.

Main Methods:

• A systematic literature search was conducted across Ovid MEDLINE, Ovid Embase, and PubMed databases, adhering to PRISMA guidelines.
• Data extraction, quality assessment, and meta-analysis were performed on selected studies involving BTLE patients treated with VNS, RNS, or DBS.
• Seizure reduction rates and complication rates were compared across the three neuromodulation modalities.

Main Results:

• The meta-analysis included 12 studies (2 VNS, 5 RNS, 5 DBS) involving 142 BTLE patients.
• Comparable efficacy was observed between VNS (61.69%), RNS (67.51%), and DBS (66.68%), with no statistically significant difference (p = 0.932).
• Complication rates also did not significantly differ among VNS, RNS, and DBS (p = 0.85).

Conclusions:

• VNS, RNS, and DBS demonstrate comparable efficacy and safety in managing refractory BTLE, supporting their consideration in treatment planning.
• Clinical decisions should integrate patient-specific factors, including candidacy, preferences, comorbidities, and potential side effects.
• Further research, including standardized reporting and head-to-head trials, is crucial for optimizing neuromodulation strategies for BTLE.