Vagus Nerve Stimulation and Seizure Outcomes in Pediatric Refractory Epilepsy

医学 迷走神经电刺激 癫痫 荟萃分析 科克伦图书馆 置信区间 梅德林 儿科 随机对照试验 迷走神经 内科学 刺激 精神科 政治学 法学
作者
Puneet Jain,Ravindra Arya
出处
期刊:Neurology [Lippincott Williams & Wilkins]
卷期号:96 (22): 1041-1051 被引量:58
标识
DOI:10.1212/wnl.0000000000012030
摘要

Objective

We synthesized evidence for effectiveness of vagus nerve stimulation (VNS) as adjuvant therapy in pediatric drug-resistant epilepsy (DRE) by obtaining pooled estimates for seizure outcomes and analyzing their determinants.

Methods

MEDLINE, EMBASE, and Cochrane databases were searched up to July 2019 for original research on VNS in pediatric (≤18 years of age) epilepsy. The primary outcome was 50% responder rate (50% RR), the proportion of patients with ≥50% seizure reduction, at the last reported follow-up. Other outcomes included a 50% RR and proportion of seizure-free patients at additional reported time points. A random-effects meta-analysis with restricted maximum likelihood estimation was performed to obtain pooled effect estimates. Meta-regression using multiple linear models was performed to obtain determinants of seizure outcomes and sources of heterogeneity.

Results

A total of 101 studies were included. The pooled prevalence estimates for a 50% RR and seizure freedom at last follow-up (mean 2.54 years) were 56.4% (95% confidence intervals [CIs] 52.4, 60.4) and 11.6% (95% CI 9.6, 13.9), respectively. Fewer antiseizure medications (ASMs) tried before VNS and later age at onset of seizures were associated with better seizure outcomes following VNS implantation. An effect of sex distribution of studies on long-term outcomes and a potential publication bias for short-term outcomes were also observed.

Conclusion

Pooled evidence supports possible effectiveness of VNS in pediatric DRE, although complete seizure freedom is less common. Early referral (fewer trials of ASMs) may be a modifiable factor for desirable seizure outcomes with VNS from a clinical perspective.
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