Iranian Center of Neurological Research Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Tehran University of Medical Sciences, Tehran, Iran.
Neurosurg Rev. 2024 Nov 19;47(1):855. doi: 10.1007/s10143-024-03090-9.
In the context of drug-resistant epilepsy, deep brain stimulation (DBS) has received FDA approval. However, there have been reports of potential adverse effects, such as depression and memory impairment associated with DBS.This systematic review and meta-analysis aimed to investigate the impact of DBS on the quality of life (QoL), and seizure frequency of patients who had DRE, and assess its potential adverse events. The study followed PRISMA guidelines and thoroughly assessed databases, including Pubmed, Scopus, Embase, Web of Science, and the Cochrane Library, up to 31 July. Statistical analysis, fixed effect model analysis, performed by the Comprehensive Meta-analysis software (CMA) version 3.0. Additionally, Cochran's Q test was conducted to determine the statistical heterogeneity. The systematic review encompassed 54 studies, with 38 studies included in the subsequent meta-analysis. The total number of patients included in the studies was 999. The findings indicated a significant decrease in the mean seizure frequency of subjects following DBS (SMD: 0.609, 95% CI: 0.519 to 0.700, p-value < 0.001). Moreover, patients' QoL significantly improved after DBS (SMD: -0.442, 95% CI: -0.576 to -0.308, p-value < 0.001). The hippocampus displayed the most notable effect size among the different DBS targets. Subgroup analysis based on follow-up duration revealed increased DBS efficacy after two years. There are few reports of adverse events, such as insertional-related complications, infection, and neuropsychiatric complications, but the majority of these were temporary and non-fatal. DBS emerged as an effective and safe procedure for reducing seizure frequency and enhancing the quality of life in DRE patients, with minimal adverse events. Furthermore, the efficacy of DBS was observed to improve over time.
在耐药性癫痫的背景下，深部脑刺激（DBS）已获得 FDA 的批准。然而，有报道称 DBS 可能会产生一些不良反应，如抑郁和记忆障碍。本系统评价和荟萃分析旨在调查 DBS 对 DRE 患者生活质量（QoL）和癫痫发作频率的影响，并评估其潜在的不良事件。该研究遵循 PRISMA 指南，并彻底评估了包括 Pubmed、Scopus、Embase、Web of Science 和 Cochrane Library 在内的数据库，截止日期为 2023 年 7 月 31 日。使用 Comprehensive Meta-analysis 软件（CMA）版本 3.0 进行统计分析和固定效应模型分析。此外，还进行了 Cochran's Q 检验，以确定统计异质性。系统评价包括 54 项研究，其中 38 项研究纳入后续荟萃分析。研究中纳入的患者总数为 999 例。研究结果表明，DBS 后患者的平均癫痫发作频率显著降低（SMD：0.609，95%CI：0.519 至 0.700，p 值<0.001）。此外，DBS 后患者的 QoL 显著改善（SMD：-0.442，95%CI：-0.576 至 -0.308，p 值<0.001）。不同 DBS 靶点中，海马区的效应量最大。基于随访时间的亚组分析显示，DBS 的疗效在两年后增加。不良事件报告较少，如插入相关并发症、感染和神经精神并发症，但大多数是暂时的且非致命的。DBS 是一种有效且安全的治疗方法，可降低 DRE 患者的癫痫发作频率并提高生活质量，且不良事件较少。此外，DBS 的疗效随着时间的推移而提高。
