Abstract Details

Title Neurostimulation in People with Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis from the ILAE Surgical Therapies Commission

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-001

Objective Summarize the current evidence on efficacy and tolerability of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) through a systematic review and meta-analysis.

Background Drug-resistant epilepsy (DRE) accounts for one third of cases of epilepsy. Resection or disconnection is the most effective approach for individuals with focal epilepsy, but in patients who are not candidates, neuromodulation is an alternative. Each modality presents unique advantages and limitations.

Design/Methods We followed the PRISMA reporting standards. We included published randomized controlled trials (RCT), their corresponding open-label extension studies, and prospective case series, with ≥ 20 participants. Our primary outcome was the mean percentage decrease in frequency, as compared to baseline, of seizures at last follow-up. Secondary outcomes included proportion of treatment responders and proportion with seizure freedom.

Results

We identified 30 eligible studies, including six RCTs. At long-term follow-up (mean 1.3 years), five observational studies for VNS reported a pooled mean percentage decrease in seizure frequency of 34.7% (95% CI: -5.1, 74.5). In the open-label studies for RNS, the median seizure reduction was 53%, 66%, and 75% at two, five, and nine years of follow-up. For DBS, the median reduction was 56%, 65%, and 75% at two, five, and seven years. The proportion of individuals with seizure freedom increased significantly over time for DBS and RNS while a positive trend was observed for VNS. Quality of life was improved in all modalities. The most common complications included hoarseness, cough and throat pain for VNS and implant site pain, headache, and dysesthesia for DBS and RNS.

Conclusions

Neurostimulation modalities are an effective treatment option for DRE, with improving outcomes over time and few major complications. Seizure reduction rates among the three therapies were similar during the initial blinded phase. Recent long-term follow-up studies are encouraging for RNS and DBS but are lacking for VNS.

Authors/Disclosures
Benedicte Dansereau, MD PRESENTER	Dr. Dansereau has nothing to disclose.
Lahoud Touma, MD (Stanford Healthcare)	Dr. Touma has nothing to disclose.
	No disclosure on file
Nathalie Jette, MD, MSc, FRCPC, FAAN (University of Calgary)	Dr. Jette has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE Epilepsia. The institution of Dr. Jette has received research support from NIH. The institution of Dr. Jette has received research support from AES.
Churl-Su Kwon, MBBS (Columbia University)	Dr. Kwon has nothing to disclose.
	No disclosure on file
Daniel Friedman, MD, FAAN (NYU Langone Medical Center)	The institution of Dr. Friedman has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Epilepsy Study Consortium (non-profit). Dr. Friedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Meili Technology. Dr. Friedman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis. Dr. Friedman has stock in Neuroview Technology. The institution of Dr. Friedman has received research support from NIH. The institution of Dr. Friedman has received research support from CDC. The institution of Dr. Friedman has received research support from Epitel. The institution of Dr. Friedman has received research support from Neuropace. The institution of Dr. Friedman has received research support from Rapport Therapeutics. Dr. Friedman has received intellectual property interests from a discovery or technology relating to health care. Dr. Friedman has received intellectual property interests from a discovery or technology relating to health care. Dr. Friedman has received publishing royalties from a publication relating to health care. Dr. Friedman has received personal compensation in the range of $500-$4,999 for serving as a Speaker Honorarium with SK Life Sciences. Dr. Friedman has received personal compensation in the range of $500-$4,999 for serving as a Speaker Honorarium with AAN. Dr. Friedman has received personal compensation in the range of $500-$4,999 for serving as a Travel Reimbursement with Epilepsy Foundation of America.
Lara Jehi, MD (Cleveland Clinic Epilepsy Center)	Dr. Jehi has nothing to disclose.
	No disclosure on file
	No disclosure on file
Lily Wong-Kisiel, MD, FAAN (Mayo Clinic)	Dr. Wong-Kisiel has nothing to disclose.
	No disclosure on file
Mark R. Keezer, MD, PhD (Centre Hospitalier Universite de Montreal)	The institution of Dr. Keezer has received research support from TD Bank. The institution of Dr. Keezer has received research support from Savoy Foundation. The institution of Dr. Keezer has received research support from Canadian Institutes of Health Research. The institution of Dr. Keezer has received research support from Fonds de Recherche Québec Santé. The institution of Dr. Keezer has received research support from Canadian Institutes of Health Research. The institution of Dr. Keezer has received research support from Precision Child Health Partnership Catalyst Program.

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