1
|
Li Q, Shan Y, Wei P, Zhao G. The comparison of DBS and RNS for adult drug-resistant epilepsy: a systematic review and meta-analysis. Front Hum Neurosci 2024; 18:1429223. [PMID: 38962148 PMCID: PMC11220164 DOI: 10.3389/fnhum.2024.1429223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024] Open
Abstract
Objective Neuromodulation has been proven to be a promising alternative treatment for adult patients with drug-resistant epilepsy (DRE). Deep brain stimulation (DBS) and responsive neurostimulation (RNS) were approved by many countries for the treatment of DRE. However, there is a lack of systematic studies illustrating the differences between them. This meta-analysis is performed to assess the efficacy and clinical characteristics of DBS and RNS in adult patients with DRE. Methods PubMed, Web of Science, and Embase were retrieved to obtain related studies including adult DRE patients who accepted DBS or RNS. The clinical characteristics of these patients were compiled for the following statistical analysis. Results A total of 55 studies (32 of DBS and 23 of RNS) involving 1,568 adult patients with DRE were included in this meta-analysis. There was no significant difference in seizure reduction and responder rate between DBS and RNS for DRE. The seizure reduction of DBS and RNS were 56% (95% CI 50-62%, p > 0.05) and 61% (95% CI 54-68%, p > 0.05). The responder rate of DBS and RNS were 67% (95% CI 58-76%, p > 0.05) and 71% (95% CI 64-78%, p > 0.05). Different targets of DBS did not show significant effect on seizure reduction (p > 0.05). Patients with DRE who accepted DBS were younger than those of RNS (32.9 years old vs. 37.8 years old, p < 0.01). The mean follow-up time was 47.3 months for DBS and 39.5 months for RNS (p > 0.05). Conclusion Both DBS and RNS are beneficial and alternative therapies for adult DRE patients who are not eligible to accept resection surgery. Further and larger studies are needed to clarify the characteristics of different targets and provide tailored treatment for patients with DRE.
Collapse
Affiliation(s)
- Qinghua Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Research Center for Epilepsy Capital Medical University, Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| |
Collapse
|
2
|
Yuruk D, Ozger C, Garzon JF, Nakonezny PA, Vande Voort JL, Croarkin PE. A retrospective, naturalistic study of deep brain stimulation and vagal nerve stimulation in young patients. Brain Behav 2024; 14:e3452. [PMID: 38468454 PMCID: PMC10928335 DOI: 10.1002/brb3.3452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Invasive neuromodulation interventions such as deep brain stimulation (DBS) and vagal nerve stimulation (VNS) are important treatments for movement disorders and epilepsy, but literature focused on young patients treated with DBS and VNS is limited. This retrospective study aimed to examine naturalistic outcomes of VNS and DBS treatment of epilepsy and dystonia in children, adolescents, and young adults. METHODS We retrospectively assessed patient demographic and outcome data that were obtained from electronic health records. Two researchers used the Clinical Global Impression scale to retrospectively rate the severity of neurologic and psychiatric symptoms before and after patients underwent surgery to implant DBS electrodes or a VNS device. Descriptive and inferential statistics were used to examine clinical effects. RESULTS Data from 73 patients were evaluated. Neurologic symptoms improved for patients treated with DBS and VNS (p < .001). Patients treated with DBS did not have a change in psychiatric symptoms, whereas psychiatric symptoms worsened for patients treated with VNS (p = .008). The frequency of postoperative complications did not differ between VNS and DBS groups. CONCLUSION Young patients may have distinct vulnerabilities for increased psychiatric symptoms during treatment with invasive neuromodulation. Child and adolescent psychiatrists should consider a more proactive approach and greater engagement with DBS and VNS teams that treat younger patients.
Collapse
Affiliation(s)
- Deniz Yuruk
- Research Fellow in the Department of Psychiatry and PsychologyMayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Can Ozger
- Department of Psychiatry and PsychologyMayo Clinic Children's Research Center, and Mayo Clinic Depression Center, Mayo ClinicRochesterMinnesotaUSA
| | - Juan F. Garzon
- Research Fellow in the Department of Psychiatry and PsychologyMayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Paul A. Nakonezny
- Department Of Population And Data SciencesUT Southwestern Medical CenterDallasTexasUSA
| | - Jennifer L. Vande Voort
- Department of Psychiatry and PsychologyMayo Clinic Children's Research Center, and Mayo Clinic Depression Center, Mayo ClinicRochesterMinnesotaUSA
| | - Paul E. Croarkin
- Department of Psychiatry and PsychologyMayo Clinic Children's Research Center, and Mayo Clinic Depression Center, Mayo ClinicRochesterMinnesotaUSA
| |
Collapse
|
3
|
Sharma A, Parfyonov M, Tiefenbach J, Hogue O, Nero N, Jehi L, Serletis D, Bingaman W, Gupta A, Rammo R. Predictors of therapeutic response following thalamic neuromodulation for drug-resistant pediatric epilepsy: A systematic review and individual patient data meta-analysis. Epilepsia 2024; 65:542-555. [PMID: 38265348 DOI: 10.1111/epi.17883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/02/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
We sought to perform a systematic review and individual participant data meta-analysis to identify predictors of treatment response following thalamic neuromodulation in pediatric patients with medically refractory epilepsy. Electronic databases (MEDLINE, Ovid, Embase, and Cochrane) were searched, with no language or data restriction, to identify studies reporting seizure outcomes in pediatric populations following deep brain stimulation (DBS) or responsive neurostimulation (RNS) implantation in thalamic nuclei. Studies featuring individual participant data of patients with primary or secondary generalized drug-resistant epilepsy were included. Response to therapy was defined as >50% reduction in seizure frequency from baseline. Of 417 citations, 21 articles reporting on 88 participants were eligible. Mean age at implantation was 13.07 ± 3.49 years. Fifty (57%) patients underwent DBS, and 38 (43%) RNS. Sixty (68%) patients were implanted in centromedian nucleus and 23 (26%) in anterior thalamic nucleus, and five (6%) had both targets implanted. Seventy-four (84%) patients were implanted bilaterally. The median time to last follow-up was 12 months (interquartile range = 6.75-26.25). Sixty-nine percent of patients achieved response to treatment. Age, target, modality, and laterality had no significant association with response in univariate logistic regression. Until thalamic neuromodulation gains widespread approval for use in pediatric patients, data on efficacy will continue to be limited to small retrospective cohorts and case series. The inherent bias of these studies can be overcome by using individual participant data. Thalamic neuromodulation appears to be a safe and effective treatment for epilepsy. Larger, prolonged prospective, multicenter studies are warranted to further evaluate the efficacy of DBS over RNS in this patient population where resection for curative intent is not a safe option.
Collapse
Affiliation(s)
- Akshay Sharma
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Maksim Parfyonov
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jakov Tiefenbach
- Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Neil Nero
- Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Demitre Serletis
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ajay Gupta
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Rammo
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
4
|
Cukiert A, Cukiert CM, Burattini JA, Guimaraes RB. Combined Neuromodulation (Vagus Nerve Stimulation and Deep Brain Stimulation) in Patients With Refractory Generalized Epilepsy: An Observational Study. Neuromodulation 2023; 26:1742-1746. [PMID: 36109334 DOI: 10.1016/j.neurom.2022.08.449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION This article describes our findings while treating patients with refractory generalized epilepsy with combined vagus nerve stimulation (VNS) and centro-median deep brain stimulation (CMDBS). MATERIALS AND METHODS A total of 11 consecutive patients with refractory generalized epilepsy (ten with Lennox-Gastaut syndrome) previously submitted to VNS and who subsequently underwent CMDBS were retrospectively studied. The VNS final parameters were 2 to 2.5 mA, 30 Hz, and 500 μs, cycling mode, 30 seconds "on" and 5 minutes "off" for all patients. The CMDBS final parameters were 4 to 5 V, 130 Hz, and 300 μs, bipolar, continuous stimulation in all patients. RESULTS There were eight male participants, ranging in age from eight to 49 years (mean 19 years). Follow-up time after VNS ranged from 18 to 132 months (mean 52 months) and from an additional 18 to 164 months (mean 42 months) during combined VNS-CMDBS. All patients had daily seizures. Atypical absences were noted in eight patients, tonic seizures in seven, bilateral tonic-clonic seizures in four, atonic seizures in three, and myoclonic seizures in two patients. Four patients were initially considered responders to VNS. All these patients also had an additional >50% seizure frequency reduction during combined VNS-CMDBS. Seven patients were not responders to VNS, and of those, four had an additional >50% seizure frequency reduction during combined VNS-CMDBS. Eight patients had an additional >50% reduction in seizure frequency when moved from VNS alone to VNS-CMDBS therapy. There were two nonresponders during combined VNS-CMDBS therapy, and both were nonresponders to VNS alone. Nine patients were considered responders during VNS-CMDBS combined therapy compared with baseline. DISCUSSION This study showed that combined VNS-CMDBS therapy was able to double the number of responders compared with VNS alone in a cohort of patients with refractory generalized epilepsy. We believe these data represent the first evidence that combined neuromodulation may be useful in this quite homogeneous patient population.
Collapse
Affiliation(s)
- Arthur Cukiert
- Department of Neurosurgery, São Paulo Epilepsy Clinic, São Paulo, São Paulo, Brazil.
| | | | | | | |
Collapse
|
5
|
Haneef Z, Skrehot HC. Neurostimulation in generalized epilepsy: A systematic review and meta-analysis. Epilepsia 2023; 64:811-820. [PMID: 36727550 DOI: 10.1111/epi.17524] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are three neurostimulation devices available to treat generalized epilepsy: vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). However, the choice between them is unclear due to lack of head-to-head comparisons. A systematic comparison of neurostimulation outcomes in generalized epilepsy has not been performed previously. The goal of this meta-analysis was to determine whether one of these devices is better than the others to treat generalized epilepsy. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of PubMed, Embase, and Web of Science was performed for studies reporting seizure outcomes following VNS, RNS, and DBS implantation in generalized drug-resistant epilepsy between the first pivotal trial study for each modality through August 2022. Specific search criteria were used for VNS ("vagus", "vagal", or "VNS" in the title and "epilepsy" or "seizure"), DBS ("deep brain stimulation", "DBS", "anterior thalamic nucleus", "centromedian nucleus", or "thalamic stimulation" in the title and "epilepsy" or "seizure"), and RNS ("responsive neurostimulation" or "RNS" in the title and "epilepsy" or "seizure"). From 4409 articles identified, 319 underwent full-text reviews, and 20 studies were included. Data were pooled using a random-effects model using the meta package in R. RESULTS Sufficient data for meta-analysis were available from seven studies for VNS (n = 510) and nine studies for DBS (n = 87). Data from RNS (five studies, n = 18) were insufficient for meta-analysis. The mean (SD) follow-up durations were as follows: VNS, 39.1 (23.4) months; DBS, 23.1 (19.6) months; and RNS, 22.3 (10.6) months. Meta-analysis showed seizure reductions of 48.3% (95% confidence interval [CI] = 38.7%-57.9%) for VNS and 64.8% (95% CI = 54.4%-75.2%) for DBS (p = .02). SIGNIFICANCE Our meta-analysis indicates that the use of DBS may lead to greater seizure reduction than VNS in generalized epilepsy. Results from RNS use are promising, but further research is required.
Collapse
Affiliation(s)
- Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.,Neurology Care Line, VA Medical Center, Houston, Texas, USA
| | - Henry C Skrehot
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
6
|
Cukiert A, Cukiert CM. Response to: Dual Device Neuromodulation Can Be Effective in Drug Resistant Generalized Epilepsies. Neuromodulation 2023; 26:481. [PMID: 36740279 DOI: 10.1016/j.neurom.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Arthur Cukiert
- São Paulo Epilepsy Clinic, São Paulo, São Paulo, Brazil.
| | | |
Collapse
|
7
|
Alcala-Zermeno JL, Gregg NM, Starnes K, Mandrekar JN, Van Gompel JJ, Miller K, Worrell G, Lundstrom BN. Invasive neuromodulation for epilepsy: Comparison of multiple approaches from a single center. Epilepsy Behav 2022; 137:108951. [PMID: 36327647 PMCID: PMC9934010 DOI: 10.1016/j.yebeh.2022.108951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Drug-resistant epilepsy (DRE) patients not amenable to epilepsy surgery can benefit from neurostimulation. Few data compare different neuromodulation strategies. OBJECTIVE Compare five invasive neuromodulation strategies for the treatment of DRE: anterior thalamic nuclei deep brain stimulation (ANT-DBS), centromedian thalamic nuclei DBS (CM-DBS), responsive neurostimulation (RNS), chronic subthreshold stimulation (CSS), and vagus nerve stimulation (VNS). METHODS Single center retrospective review and phone survey for patients implanted with invasive neuromodulation for 2004-2021. RESULTS N = 159 (ANT-DBS = 38, CM-DBS = 19, RNS = 30, CSS = 32, VNS = 40). Total median seizure reduction (MSR) was 61 % for the entire cohort (IQR 5-90) and in descending order: CSS (85 %), CM-DBS (63 %), ANT-DBS (52 %), RNS (50 %), and VNS (50 %); p = 0.07. The responder rate was 60 % after a median follow-up time of 26 months. Seizure severity, life satisfaction, and quality of sleep were improved. Cortical stimulation (RNS and CSS) was associated with improved seizure reduction compared to subcortical stimulation (ANT-DBS, CM-DBS, and VNS) (67 % vs. 52 %). Effectiveness was similar for focal epilepsy vs. generalized epilepsy, closed-loop vs. open-loop stimulation, pediatric vs. adult cases, and high frequency (>100 Hz) vs. low frequency (<100 Hz) stimulation settings. Delivered charge per hour varied widely across approaches but was not correlated with improved seizure reduction. CONCLUSIONS Multiple invasive neuromodulation approaches are available to treat DRE, but little evidence compares the approaches. This study used a uniform approach for single-center results and represents an effort to compare neuromodulation approaches.
Collapse
Affiliation(s)
- Juan Luis Alcala-Zermeno
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Neurology, Jefferson Medical College, Thomas Jefferson University, 901 Walnut Street, Suite 400, Philadelphia, PA 19107, USA.
| | - Nicholas M. Gregg
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Keith Starnes
- Division of Child and Adolescent Neurology, Department of Neurology, 200 First St SW, Rochester, MN 55905, USA.
| | - Jayawant N. Mandrekar
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jamie J. Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kai Miller
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Brian N. Lundstrom
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| |
Collapse
|
8
|
Hebel JM, Holtkamp M. Epilepsy surgery in older patients – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
9
|
Cheung EYH, Lau CKY, Leung HHW, Fung ELW, Tang VYH, Cheung TCY, Kwong WKM, Zhu XL, Chan DYC, Chan DTM, Poon WS. Deep brain stimulation of the anterior nucleus of the thalamus for drug‐resistant epilepsy: Long‐term efficacy and outcomes from a prospective cohort. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eric Y. H. Cheung
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - Claire K. Y. Lau
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
- Divsion of Neurology, Department of Medicine and Therapeutics Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Howan H. W. Leung
- Divsion of Neurology, Department of Medicine and Therapeutics Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Eva L. W. Fung
- Department of Paediatrics Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Venus Y. H. Tang
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
- Department of Clinical Psychology Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Tom C. Y. Cheung
- Department of Organ Imaging and Diagnostic Radiology Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - William K. M. Kwong
- Department of Organ Imaging and Diagnostic Radiology Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Xian Lun Zhu
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - David Y. C. Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - Danny T. M. Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| |
Collapse
|
10
|
Caccavella VM, Giordano M, Colicchio G, Izzo A, D’Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Montano N. Palliative surgery for drug resistant epilepsy in adult patients. A systematic review of the literature and a pooled analysis of outcomes. World Neurosurg 2022; 163:132-140.e1. [DOI: 10.1016/j.wneu.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
|