Please use this identifier to cite or link to this item: https://doi.org/10.1007/s10143-022-01757-9
Title: Vagus nerve stimulation for treatment of drug-resistant epilepsy: a systematic review and meta-analysis
Authors: Rui, Lim Mervyn Jun 
Yung, Fong Khi
Zheng, Yilong
Kit, Chua Christopher Yuan
Miny, Samuel 
Lin, Jeremy Bingyuan 
Nga, Vincent Diong Weng 
Ong, Hian Tat 
Rathakrishnan, Rahul 
Yeo, Tseng Tsai
Keywords: Systematic review
Meta-analysis
Vagus nerve stimulation
Epilepsy
Issue Date: Jun-2022
Publisher: SPRINGER
Citation: Rui, Lim Mervyn Jun, Yung, Fong Khi, Zheng, Yilong, Kit, Chua Christopher Yuan, Miny, Samuel, Lin, Jeremy Bingyuan, Nga, Vincent Diong Weng, Ong, Hian Tat, Rathakrishnan, Rahul, Yeo, Tseng Tsai (2022-06). Vagus nerve stimulation for treatment of drug-resistant epilepsy: a systematic review and meta-analysis. NEUROSURGICAL REVIEW 45 (3) : 2361-2373. ScholarBank@NUS Repository. https://doi.org/10.1007/s10143-022-01757-9
Abstract: To analyze the efficacy and safety of high-frequency VNS versus control (low-frequency VNS or no VNS) in patients with DRE using data from randomized controlled trials (RCTs). An electronic literature search was conducted on PubMed, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL); 12 RCTs reporting seizure frequency or treatment response in studies containing a high-frequency VNS treatment arm (conventional VNS or transcutaneous VNS [tVNS]) compared to control (low-frequency VNS or no VNS) were included. Seizure frequency, treatment response (number of patients with ≥ 50% reduction in seizure frequency), quality of life (QOL), and adverse effects were analyzed. Seizure frequency was reported in 9 studies (718 patients). Meta-analysis with random-effects models favored high-frequency VNS over control (standardized mean difference = 0.82, 95%-CI = 0.39–1.24, p <.001). This remained significant for subgroup analyses of low-frequency VNS as the control, VNS modality, and after removing studies with moderate-to-high risk of bias. Treatment response was reported in 8 studies (758 patients). Random-effects models favored high-frequency VNS over control (risk ratio = 1.57, 95%-CI = 1.19–2.07, p <.001). QOL outcomes were reported descriptively in 4 studies (363 patients), and adverse events were reported in 11 studies (875 patients). Major side effects and death were not observed to be more common in high-frequency VNS compared to control. High-frequency VNS results in reduced seizure frequency and improved treatment response compared to control (low-frequency VNS or no VNS) in patients with drug-resistant epilepsy. Greater consideration for VNS in patients with DRE may be warranted to decrease seizure frequency in the management of these patients.
Source Title: NEUROSURGICAL REVIEW
URI: https://scholarbank.nus.edu.sg/handle/10635/245777
ISSN: 0344-5607
1437-2320
DOI: 10.1007/s10143-022-01757-9
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