Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis.

dc.contributor.author

Batson, Sarah

dc.contributor.author

Shankar, Rohit

dc.contributor.author

Conry, Joan

dc.contributor.author

Boggs, Jane

dc.contributor.author

Radtke, Rodney

dc.contributor.author

Mitchell, Stephen

dc.contributor.author

Barion, Francesca

dc.contributor.author

Murphy, Joanna

dc.contributor.author

Danielson, Vanessa

dc.date.accessioned

2024-05-08T11:43:37Z

dc.date.available

2024-05-08T11:43:37Z

dc.date.issued

2022-06

dc.description.abstract

Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) for the management of adults with DRE. A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print, Embase, and the Cochrane library databases. Outcomes examined included reduction in seizure frequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs). Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy. Four RCTs and six comparative observational studies were identified for inclusion. Against comparators, individuals treated with VNS had a significantly better odds of experiencing a ≥ 50% reduction in seizure frequency (OR: 2.27 [95% CI 1.47, 3.51]; p = 0.0002), a ≥ 75% reduction in seizure frequency (OR: 3.56 [95% CI 1.59, 7.98]; p = 0.002) and a reduced risk for increased ASM load (risk ratio: 0.36 [95% CI 0.21, 0.62]; p = 0.0002). There was no difference in the odds of discontinuation or the rate of SAEs between VNS versus comparators. This meta-analysis demonstrated the benefits of VNS Therapy in people with DRE, which included improvement in seizure frequency without an increase in the rate of SAEs or discontinuations, thereby supporting the consideration of VNS Therapy for people who are not responding to ASMs and those unsuitable or unwilling to undergo surgery.

dc.identifier

10.1007/s00415-022-10967-6

dc.identifier.issn

0340-5354

dc.identifier.issn

1432-1459

dc.identifier.uri

https://hdl.handle.net/10161/30685

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

Journal of neurology

dc.relation.isversionof

10.1007/s00415-022-10967-6

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

dc.subject

Seizures

dc.subject

Treatment Outcome

dc.subject

Adult

dc.subject

Medication Therapy Management

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Vagus Nerve Stimulation

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Drug Resistant Epilepsy

dc.title

Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis.

dc.type

Journal article

pubs.begin-page

2874

pubs.end-page

2891

pubs.issue

6

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Neurology

pubs.organisational-group

Neurology, Epilepsy and Sleep

pubs.publication-status

Published

pubs.volume

269

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