Systematic Review and Meta-analysis of Responsive Neurostimulation in Epilepsy
Abstract number :
1.317
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2203962
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Dorian Kusyk, MD – Allegheny Health Network; Justin Meinert, B. Phil – Medical Student, College of Medicine, Drexel University; Kristen Stabingas, MD – Resident, Neurosurgery, Allegheny Health Network; Yue Yin, PhD – Allegheny Health Network; Alexander Whiting, MD – Attending, Neurosurgery, Allegheny Health Network
Rationale: Neuromodulatory implants provide promising alternatives for drug resistant epilepsy (DRE) patients in whom resective or ablative surgery is not an option. Responsive neurostimulation (RNS) operates a unique “closed loop” system of electrocorticography-triggered stimulation for seizure control. A comprehensive review of the current literature would be valuable to guide clinical decision making regarding RNS.
Methods: Following PRISMA protocols, a systematic PubMed literature review was performed to identify appropriate studies involving patients undergoing RNS for DRE. Full texts of included studies were analyzed and extracted data regarding demographics, seizure reduction rate, responder rate (defined as patients with >50% seizure reduction), and complications were compiled for comprehensive statistical analysis.
Results: A total of 313 studies were screened and 17 studies were included in the final review, representative of 541 patients. Mean seizure reduction rate was 68% [95% CI, 61%-76%] and mean responder rate was 68% [95% CI, 60%-5%]. See Figure 1 for details. Complications occurred in 102/541 patients with a complication rate of 18.9%. A strong publication bias toward higher seizure reduction rate and increased responder rate was demonstrated among included literature (Figure 2).
Conclusions: A meta-analysis of recent RNS for DRE literature demonstrates seizure reduction and responder rates comparable to other neuromodulatory implants for epilepsy, demonstrating both the value of this intervention and the need for further research to delineate the optimal patient populations. This analysis also demonstrates a strong publication bias toward positive primary outcomes highlighting the limitation of current literature. Currently, RNS data are optimistic for the treatment of DRE but should be cautiously interpreted.
Funding: Funding: None
Surgery