Shi Jianwei, Lu Dafeng, Wei Penghu, Yang Yanfeng, Dong Hengxin, Jin Lei, Sander Josemir W, Shan Yongzhi, Zhao Guoguang
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China.
Department of Public Health, Nanjing Medical University, Nanjing, China.
World Neurosurg. 2025 Jan;193:373-396. doi: 10.1016/j.wneu.2024.09.084. Epub 2024 Oct 16.
The study aims to evaluate the efficacy of neuromodulatory strategies for people who have drug-resistant epilepsy (DRE).
We searched electronic repositories, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, their ensuing open-label extension studies, and prospective studies focusing on surgical or neuromodulation interventions for people with DRE. We used seizure frequency reduction as the primary outcome. A single-arm meta-analysis synthesized data across all studies to assess treatment effectiveness at multiple time points. A network meta-analysis evaluated the efficacy of diverse therapies in randomized controlled trials. Grading of Recommendations, Assessment, Development, and Evaluations was applied to evaluate the overall quality of the evidence.
Twenty-eight studies representing 2936 individuals underwent 10 treatments were included. Based on the cumulative ranking in the network meta-analysis, the top 3 neuromodulatory options were deep brain stimulation (DBS) with 27% probability, responsive neurostimulation (RNS) with 22.91%, and transcranial direct current stimulation with 24.31%. In the single-arm meta-analysis, in the short-to-medium term, seizure control is more effective with RNS than with invasive vagus nerve stimulation (inVNS), which in turn is slightly more effective than DBS, though the differences are minimal. However, in the long term, inVNS appears to be less effective than both DBS and RNS. Trigeminal nerve stimulation, transcranial magnetic stimulation, and transcranial alternating current stimulation did not demonstrate significant seizure frequency reduction.
Regarding long-term efficacy, RNS and DBS outperformed inVNS. While transcranial direct current stimulation and transcutaneous auricular VNS showed promise for treating DRE, further studies are needed to confirm their long-term efficacy.
本研究旨在评估神经调节策略对耐药性癫痫（DRE）患者的疗效。
我们在包括PubMed、科学网、Embase和Cochrane图书馆在内的电子数据库中搜索了随机对照试验、随后的开放标签扩展研究以及针对DRE患者的手术或神经调节干预的前瞻性研究。我们将癫痫发作频率降低作为主要结果。单臂荟萃分析综合了所有研究的数据，以评估多个时间点的治疗效果。网络荟萃分析评估了随机对照试验中不同疗法的疗效。应用推荐分级、评估、制定和评价系统来评估证据的整体质量。
纳入了代表2936名个体接受10种治疗的28项研究。根据网络荟萃分析中的累积排名，排名前三的神经调节方法分别是：深部脑刺激（DBS），概率为27%；反应性神经刺激（RNS），为22.91%；经颅直流电刺激，为24.31%。在单臂荟萃分析中，在短期至中期，RNS控制癫痫发作比侵入性迷走神经刺激（inVNS）更有效，而inVNS又比DBS略有效，尽管差异很小。然而，从长期来看，inVNS似乎比DBS和RNS都要差。三叉神经刺激、经颅磁刺激和经颅交流电刺激并未显示出癫痫发作频率的显著降低。
就长期疗效而言，RNS和DBS优于inVNS。虽然经颅直流电刺激和经皮耳迷走神经刺激在治疗DRE方面显示出前景，但需要进一步研究来证实它们的长期疗效。
