Significant reduction of seizure frequency in patients with drug-resistant epilepsy by vagus nerve stimulation: Systematic review and meta-analysis

Malaisamy, Muniyandi and Karthick, Chelvanayagam and Sahil Abdul, salam and Sathishkumar, Vadamalai and Rajsekar, Kavitha and Ramachandran, Rajeswari (2025) Significant reduction of seizure frequency in patients with drug-resistant epilepsy by vagus nerve stimulation: Systematic review and meta-analysis. Significant reduction of seizure frequency in patients with drug-resistant epilepsy by vagus nerve stimulation: Systematic review and meta-analysis, 210 (107510).

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Abstract

Background: Epilepsy is a major neurological disorder, typically managed with Anti-Seizure Medication (ASM). Nevertheless, a substantial 30 % of patients did not respond satisfactorily to ASMs, classifying their condition as Drug-Resistant Epilepsy (DRE). Vagus Nerve Stimulation (VNS) was recommended as a potential solution. Objective: To evaluate clinical efficacy of VNS on patients with DRE in reduction of seizures through a systematic review and meta-analysis using a random effects model. Methods: A systematic search was done from PubMed, ScienceDirect, Cochrane Library and Google Scholar databases on observational studies and randomized controlled trials (RCTs) for the clinical effectiveness of VNS among DRE patients. A meta-analysis was performed to obtain the pooled estimate of the clinical effectiveness of VNS in terms of seizure reduction and the odds ratio (OR) for patients achieving > 50 % seizure reduction. Heterogeneity was assessed using visual inspection of forest plots and I 2 statistic. Results: A total of 1023 articles were retrieved from the electronic search. After removing duplicates, nonrelevance and non-availability of efficacy data, 28 articles were included in the final analysis. Of these, 9 are RCTs and 19 are observational studies. The pooled estimate of > 50 % seizure reduction was 0.46 (95 % CI:0.40–0.51) and the pooled estimate of the OR comparing > 50 % vs ≤ 50 % seizure reduction was 0.76 (95 % CI: 0.44–1.29). Conclusion: Our meta-analysis showed that 46 % of DRE patients have experienced ≥ 50 % seizure reduction with VNS treatment. It should be considered in patients in whom ASM has failed or who continue to experience seizures after medication.

Affiliation:	ICMR-National Institute for Research in Tuberculosis
Item Type:	Article
Uncontrolled Keywords:	Vagus nerve stimulation, Neurological disorder,Drug resistant epilepsy, Anti-seizure medication Systematic review, Meta-analysis
Subjects:	Tuberculosis Tuberculosis > Economical Research
Divisions:	Health Economics
Depositing User:	Mrs. N Lakshmi
Date Deposited:	27 Mar 2025 16:48
Last Modified:	27 Mar 2025 16:48
URI:	http://eprints.nirt.res.in/id/eprint/2024

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