第三代抗癫痫药物与非侵入性脑刺激治疗难治性癫痫的疗效与安全性：一项系统评价和网状Meta分析研究
The efficacy and safety of third-generation antiseizure medications and non-invasive brain stimulation to treat refractory epilepsy: a systematic review and network meta-analysis study.
作者信息
Yang Yang, Shangguan Yafei, Wang Xiaoming, Liu Ruihong, Shen Ziyi, Tang Ming, Jiang Guohui
机构信息
Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, China.
Department of Neurology, The First People's Hospital of Guiyang, Guiyang, China.
出版信息
Front Neurol. 2024 Jan 9;14:1307296. doi: 10.3389/fneur.2023.1307296. eCollection 2023.
BACKGROUND
The new antiseizure medications (ASMs) and non-invasive brain stimulation (NIBS) are controversial in controlling seizures. So, this network meta-analysis aimed to evaluate the efficacy and safety of five third-generation ASMs and two NIBS therapies for the treatment of refractory epilepsy.
METHODS
We searched PubMed, EMBASE, Cochrane Library and Web of Science databases. Brivaracetam (BRV), cenobamate (CNB), eslicarbazepine acetate (ESL), lacosamide (LCM), perampanel (PER), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) were selected as additional treatments for refractory epilepsy in randomized controlled studies and other cohort studies. Randomized, double-blind, placebo-controlled, add-on studies that evaluated the efficacy or safety of medication and non-invasive brain stimulation and included patients with seizures were uncontrolled by one or more concomitant ASMs were identified. A random effects model was used to incorporate possible heterogeneity. The primary outcome was the change in seizure frequency from baseline, and secondary outcomes included the proportion of patients with ≥50% reduction in seizure frequency, and the rate of treatment-emergent adverse events.
RESULTS
Forty-five studies were analyzed. The five ASMs and two NIBS decreased seizure frequency from baseline compared with placebo. The 50% responder rates of the five antiseizure drugs were significantly higher than that of placebo, and the ASMs were associated with fewer adverse events than placebo ( < 0.05). The surface under the cumulative ranking analysis revealed that ESL was most effective in decreasing the seizure frequency from baseline, whereas CNB provided the best 50% responder rate. BRV was the best tolerated. No significant publication bias was identified for each outcome index.
CONCLUSION
The five third-generation ASMs were more effective in controlling seizures than placebo, among which CNB, ESL, and LCM were most effective, and BRV exhibited better safety. Although rTMS and tDCS did not reduce seizure frequency as effectively as the five drugs, their safety was confirmed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, https://www.crd.york.ac.uk/prospero/ (CRD42023441097).
背景
新型抗癫痫药物（ASMs）和非侵入性脑刺激（NIBS）在控制癫痫发作方面存在争议。因此，本网络荟萃分析旨在评估五种第三代ASMs和两种NIBS疗法治疗难治性癫痫的疗效和安全性。
方法
我们检索了PubMed、EMBASE、Cochrane图书馆和Web of Science数据库。在随机对照研究和其他队列研究中，选择布瓦西坦（BRV）、司替戊醇（CNB）、醋酸艾司利卡西平（ESL）、拉科酰胺（LCM）、吡仑帕奈（PER）、重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）作为难治性癫痫的附加治疗方法。纳入评估药物和非侵入性脑刺激疗效或安全性且包括癫痫发作患者且未使用一种或多种联合ASMs进行对照的随机、双盲、安慰剂对照、附加研究。采用随机效应模型纳入可能的异质性。主要结局是癫痫发作频率相对于基线的变化，次要结局包括癫痫发作频率降低≥50%的患者比例以及治疗中出现的不良事件发生率。
结果
分析了45项研究。与安慰剂相比，五种ASMs和两种NIBS降低了癫痫发作频率相对于基线的水平。五种抗癫痫药物的50%缓解率显著高于安慰剂，且ASMs与安慰剂相比不良事件更少（P<0.05）。累积排名分析的曲线下面积显示，ESL在降低癫痫发作频率相对于基线的水平方面最有效，而CNB的50%缓解率最佳。BRV耐受性最佳。各结局指标均未发现明显的发表偏倚。
结论
五种第三代ASMs在控制癫痫发作方面比安慰剂更有效，其中CNB、ESL和LCM最有效，BRV安全性更好。虽然rTMS和tDCS降低癫痫发作频率的效果不如这五种药物，但它们的安全性得到了证实。
系统评价注册
PROSPERO，https://www.crd.york.ac.uk/prospero/（CRD42023441097）。
Zotero 插件