Comparison of Deep Brain Stimulation of the Hippocampus to Thalamic Targets and Responsive Neurostimulation for Adult Intractable Epilepsy: A Systematic Review and Meta-Analysis.
Norris C Talbot, James R Bridges, Patrick M Luther, Michael S Folse, Ben V Peco, Connor Galardo, Michael P C Minamyer, Ryan Diaz, Bryce Bonin, Roohi Katyal, Mostafa Hotait, Jamie Toms
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Abstract
Objective: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
目的：立体定向神经调节，如深部脑刺激（DBS）和反应性神经刺激（RNS），已经成为治疗耐药癫痫的一些更有前途的手段。本研究综合分析丘脑前核（ANT）、丘脑中位核（CMT）、海马和RNS的DBS对成人难治性癫痫发作的减少作用。方法：根据PRISMA （Preferred Reporting Items for Systematic Reviews and meta - analysis）指南，对2000年1月至2024年1月的PubMed、Cochrane Library和Embase数据库进行系统评价，客观评估各种神经调节方式对减少癫痫发作的有效性。不同的软件如EndNote和Rayyan被用来组织1996年的总审查研究，并运行一个盲法多阶段审查过程。结果：共纳入25项研究，其中21项研究和166例患者适合meta分析。DBS ANT、DBS海马和RNS均有显著的个体癫痫发作减少，分别为54.0%、70.0%和63.5%。DBS CMT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，3个分析程序被发现是不显著时，比较彼此。局灶性癫痫与全面性癫痫在DBS ANT中也无显著差异。与影像学表现正常的患者相比，内侧颞叶硬化患者的DBS海马减少率明显更高。结论：这些结果为神经刺激手术提供了大量的支持数据，同时也表明两种手术之间没有显著差异。因此，在这一目标人群中，可以根据外科医生的偏好和患者的情况做出手术决定，而不会影响减少癫痫发作的结果。
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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