Abstract：
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.
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.
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.
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.
The results help guide neuromodulation treatment in eligible patients with drug-resistant focal epilepsy.
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.
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.
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.
The results help guide neuromodulation treatment in eligible patients with drug-resistant focal epilepsy.
摘要：
目的：当手术不是一种选择，包括迷走神经刺激（VNS）时，不同的神经刺激方式可用于治疗耐药性局灶性癫痫，反应性神经刺激（RNS），脑深部电刺激（DBS）。它们之间不存在疗效的头对头比较，将来也不可能。我们对VNS进行了荟萃分析，RNS,和DBS结果比较局灶性癫痫发作减少疗效。
方法：我们系统回顾了文献报道的VNS植入后的癫痫发作结果，RNS,和DBS在局灶性发作性癫痫发作中的应用，并进行了荟萃分析。纳入前瞻性或回顾性临床研究。
结果：在第一年有足够的数据（n=642，2（n=480），和三个(n=385)用于比较三种模式。第一年设备的癫痫发作减少，两个,三个分别是：RNS：66.3%，56.0%,68.4%;DBS-58.4%,57.5%,63.8%；VNS32.9%，44.4%,53.5%。与VNS相比，RNS（p<0.01）和DBS（p<0.01）在第一年的癫痫发作减少更大。
结论：我们的研究结果表明，RNS的癫痫发作减少功效与DBS相似，与植入后第一年的VNS相比，两者的癫痫发作减少幅度更大，随着长期随访，差异逐渐缩小。
结论：这些结果有助于指导符合条件的耐药局灶性癫痫患者的神经调节治疗。
方法：我们系统回顾了文献报道的VNS植入后的癫痫发作结果，RNS,和DBS在局灶性发作性癫痫发作中的应用，并进行了荟萃分析。纳入前瞻性或回顾性临床研究。
结果：在第一年有足够的数据（n=642，2（n=480），和三个(n=385)用于比较三种模式。第一年设备的癫痫发作减少，两个,三个分别是：RNS：66.3%，56.0%,68.4%;DBS-58.4%,57.5%,63.8%；VNS32.9%，44.4%,53.5%。与VNS相比，RNS（p<0.01）和DBS（p<0.01）在第一年的癫痫发作减少更大。
结论：我们的研究结果表明，RNS的癫痫发作减少功效与DBS相似，与植入后第一年的VNS相比，两者的癫痫发作减少幅度更大，随着长期随访，差异逐渐缩小。
结论：这些结果有助于指导符合条件的耐药局灶性癫痫患者的神经调节治疗。
