Deep-brain stimulation affords greater seizure reduction than vagus nerve stimulation

Among the neurostimulation devices used in the treatment of generalized epilepsy, deep-brain stimulation performs better than vagus nerve stimulation at reducing seizure frequency, as reported in a study. On the other hand, while results for responsive neurostimulation are promising, further research is needed.

Researchers conducted a meta-analysis to compare the outcomes of the three neurostimulation devices available to treat generalized epilepsy: vagus nerve stimulation, deep-brain stimulation, and responsive neurostimulation. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, multiple online databases were searched for relevant studies using the following a combination of keywords.

The initial search yielded 4,409 articles, of which 20 studies met the eligibility criteria and were included in the meta-analysis. Seven studies focused on vagus nerve stimulation (n=510) and nine on deep-brain stimulation (n=87). The five studies on responsive neurostimulation (n=18) had insufficient data for meta-analysis.

The mean follow-up durations were 39.1 months for vagus nerve stimulation, 23.1 months for deep-brain stimulation, and 22.3 months for responsive neurostimulation.

Pooled data, which were obtained using a random-effects model, showed that deep-brain stimulation was associated with a significantly greater reduction in seizure frequency as compared with vagus nerve stimulation (64.8 percent, 95 percent confidence interval [CI], 54.4–75.2 vs 48.3 percent, 95 percent CI, 38.7–57.9; p=0.02).