Highlights
- •VNS, RNS, and DBS are used to treat focal epilepsy but their comparative treatment efficacy is unclear.
- •We performed a meta-analysis comparing the efficacy of these modalities in years 1–3 after implantation.
- •We found seizure reduction efficacy of RNS and DBS to be higher than VNS, but this was significant only in year 1.
Abstract
Objectives
Different neurostimulation modalities are available to treat drug-resistant focal
epilepsy when surgery is not an option including vagus nerve stimulation (VNS), responsive
neurostimulation (RNS), and deep brain stimulation (DBS). Head-to-head comparisons
of efficacy do not exist between them nor are likely to be available in the future.
We performed a meta-analysis on VNS, RNS, and DBS outcomes to compare seizure reduction
efficacy for focal epilepsy.
Methods
We systematically reviewed the literature for reported seizure outcomes following
implantation with VNS, RNS, and DBS in focal-onset seizures and performed a meta-analysis.
Prospective or retrospective clinical studies were included.
Results
Sufficient data were available at years one (n = 642, two (n = 480), and three (n = 385)
for comparing the three modalities with each other. Seizure reduction for the devices
at years one, two, and three respectively were: RNS: 66.3%, 56.0%, 68.4%; DBS- 58.4%,
57.5%, 63.8%; VNS 32.9%, 44.4%, 53.5%. Seizure reduction at year one was greater for
RNS (p < 0.01) and DBS (p < 0.01) compared to VNS.
Conclusions
Our findings indicate the seizure reduction efficacy of RNS is similar to DBS, and
both had greater seizure reductions compared to VNS in the first-year post-implantation,
with the differences diminishing with longer-term follow-up.
Significance
The results help guide neuromodulation treatment in eligible patients with drug-resistant
focal epilepsy.
Keywords
Abbreviations:
DRE (drug-resistant epilepsy), ASM (anti-seizure medications), VNS (vagus nerve stimulation), RNS (responsive neurostimulation), DBS (deep brain stimulation), ANT (anterior nucleus of the thalamus), SR (seizure reduction), SD (standard deviation), IQR (interquartile range), QoL (quality of life)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 25, 2023
Accepted:
March 12,
2023
Received in revised form:
March 10,
2023
Received:
January 16,
2023
Identification
Copyright
Published by Elsevier Inc.
