Talbot Norris C, Bridges James R, Luther Patrick M, Folse Michael S, Peco Ben V, Galardo Connor, Minamyer Michael P C, Diaz Ryan, Bonin Bryce, Katyal Roohi, Hotait Mostafa, Toms Jamie
School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, USA.
School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, USA.
World Neurosurg. 2025 Feb;194:123621. doi: 10.1016/j.wneu.2024.123621. Epub 2025 Jan 23.
Stereotactic neuromodulation, such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), have emerged as some of the more promising means for managing drug-resistant epilepsy. This study serves as a comprehensive analysis of DBS of the anterior nucleus of the thalamus (ANT), centromedian nucleus of the thalamus, and hippocampus and RNS for seizure reduction in adult intractable epilepsy.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted of PubMed, Cochrane Library, and Embase databases from January 2000 to January 2024 to objectively assess the effectiveness of the various neuromodulation modalities on seizure reduction. Different software such as EndNote and Rayyan was used to organize the 1996 total reviewed studies and to run a blinded multiphase review process.
A total of 25 studies were included for review with 21 studies and 166 patients suitable for the meta-analysis. DBS ANT, DBS hippocampus, and RNS were all found to have significant individual seizure reductions of 54.0%, 70.0%, and 63.5%, respectively. DBS centromedian nucleus of the thalamus was excluded since only 1 study met inclusion criteria and was, therefore, not suitable for meta-analysis. Furthermore, the 3 analyzed procedures were found to be not significant when compared to one another. Focal versus general epilepsy in DBS ANT also had no significant difference. DBS hippocampus had a significantly higher reduction rate in patients with mesial temporal sclerosis compared to patients with normal imaging findings.
These results provide a vast amount of supporting data for these neurostimulation procedures while also indicating no significant difference between operations. Therefore, in this target population, operative decisions can be made based on surgeon preference and patient circumstance without affecting seizure reduction outcomes.
立体定向神经调节，如深部脑刺激（DBS）和反应性神经刺激（RNS），已成为治疗耐药性癫痫更有前景的手段。本研究对丘脑前核（ANT）、丘脑中央中核和海马体的DBS以及RNS在成人难治性癫痫发作减少方面进行了全面分析。
按照系统评价和Meta分析的首选报告项目指南，对2000年1月至2024年1月的PubMed、Cochrane图书馆和Embase数据库进行系统评价，以客观评估各种神经调节方式对减少癫痫发作的有效性。使用EndNote和Rayyan等不同软件整理总共1996项纳入审查的研究，并进行双盲多阶段审查过程。
共纳入25项研究进行审查，其中21项研究和166例患者适合进行Meta分析。发现DBS ANT、DBS海马体和RNS的个体癫痫发作均有显著减少，分别为54.0%、70.0%和63.5%。丘脑中央中核的DBS被排除，因为只有1项研究符合纳入标准，因此不适合进行Meta分析。此外，发现这3种分析程序相互比较时无显著差异。DBS ANT中局灶性癫痫与全身性癫痫之间也无显著差异。与影像学检查结果正常的患者相比，DBS海马体在伴有内侧颞叶硬化的患者中癫痫发作减少率显著更高。
这些结果为这些神经刺激程序提供了大量支持数据，同时也表明手术之间无显著差异。因此，在该目标人群中，可以根据外科医生的偏好和患者情况做出手术决策，而不会影响癫痫发作减少的结果。
