Rationale:
ANT-DBS has proven its effectiveness for drug-resistant epilepsy(DRE). However, it's still unclear how well it works in patients who have already undergone epilepsy surgery. Understanding whether ANT-DBS offers additional benefits for these patients is crucial.
Methods:
We conducted this meta-analysis according to the PRISMA 2020 guidelines. Studies were included if they looked at the effectiveness of ANT-DBS in patients with or without previous epilepsy surgery. This included randomized controlled trials, retrospective case-control studies, and case series. Patients with a seizure reduction greater than 50% were classified as responders. Odds ratios were calculated based on the likelihood of non-response. Two authors independently searched PubMed, Web of Science, Cochrane CENTRAL, Scopus, and Embase for relevant articles published up to April 24, 2025.
Results:
Three subgroup meta-analyses were conducted to explore whether prior interventions influence the efficacy of ANT-DBS in DRE patients. The first analysis compared patients who had received any prior epilepsy surgery versus fresh cases with no prior operations. The pooled odds ratio (OR = 1.57; 95% CI: 0.659–3.739; p = 0.308) indicated no statistically significant difference in treatment response, suggesting similar efficacy of ANT-DBS regardless of surgical history.
The second analysis focused specifically on patients with a history of craniotomy. Again, the odds ratio (OR = 1.335; 95% CI: 0.506–3.521; p = 0.560) did not reach statistical significance.
The third subgroup analysis evaluated the impact of prior vagus nerve stimulation (VNS). The pooled odds ratio (OR = 1.242; 95% CI: 0.612–2.522; p = 0.549) demonstrated no significant difference between the VNS and non-VNS groups.
Conclusions:
These results suggest that prior surgery or neuromodulation, including craniotomy and VNS, do not significantly affect the effectiveness of ANT-DBS. This supports the use of ANT-DBS as an effective treatment option for patients with drug-resistant epilepsy, regardless of their previous treatment history.
Funding: nil