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Neurostimulation for drug-resistant epilepsy : a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response

Paul Boon (UGent) , Elien De Cock (UGent) , Ann Mertens (UGent) and Eugen Trinka
(2018) CURRENT OPINION IN NEUROLOGY. 31(2). p.198-210
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Abstract
Purpose of review: Neurostimulation is becoming an increasingly accepted treatment alternative for patients with drug-resistant epilepsy (DRE) who are unsuitable surgery candidates. Standardized guidelines on when or how to use the various neurostimulation modalities are lacking. We conducted a systematic review on the currently available neurostimulation modalities primarily with regard to effectiveness and safety. Recent findings: For vagus nerve stimulation (VNS), there is moderate-quality evidence for its effectiveness in adults with drug-resistant partial epilepsies. Moderate-to-low-quality evidence supports the efficacy and safety of deep brain stimulation (DBS) and responsive neurostimulation (RNS) in patients with DRE. There is moderate-to-very low-quality evidence that transcranial direct current stimulation (tDCS) is effective or well tolerated. For transcutaneous vagus nerve stimulation (tVNS), transcranial magnetic stimulation (TMS) and trigeminal nerve stimulation (TNS), there are insufficient data to support the efficacy of any of these modalities for DRE. These treatment modalities, nevertheless, appear well tolerated, with no severe adverse events reported. Summary: Head-to-head comparison of treatment modalities such as VNS, DBS and RNS across different epileptic syndromes are required to decide which treatment modality is the most effective for a given patient scenario. Such studies are challenging and it is unlikely that data will be available in the near future. Additional data collection on potentially promising noninvasive neurostimulation modalities like tVNS, TMS, TNS and tDCS is warranted to get a more precise estimate of their therapeutic benefit and long-term safety.
Keywords
deep brain stimulation, drug-resistant epilepsy, neurostimulation, systematic review, vagus nerve stimulation, VAGUS NERVE-STIMULATION, TRANSCRANIAL MAGNETIC STIMULATION, TEMPORAL-LOBE EPILEPSY, RANDOMIZED CONTROLLED-TRIAL, PATIENT OUTCOME REGISTRY, MEDICALLY INTRACTABLE SEIZURES, TERM-FOLLOW-UP, REFRACTORY PARTIAL SEIZURES, FAILED CRANIAL SURGERY, PARTIAL-ONSET EPILEPSY

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Citation

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Chicago
Boon, Paul, Elien De Cock, Ann Mertens, and Eugen Trinka. 2018. “Neurostimulation for Drug-resistant Epilepsy : a Systematic Review of Clinical Evidence for Efficacy, Safety, Contraindications and Predictors for Response.” Current Opinion in Neurology 31 (2): 198–210.
APA
Boon, Paul, De Cock, E., Mertens, A., & Trinka, E. (2018). Neurostimulation for drug-resistant epilepsy : a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response. CURRENT OPINION IN NEUROLOGY, 31(2), 198–210.
Vancouver
1.
Boon P, De Cock E, Mertens A, Trinka E. Neurostimulation for drug-resistant epilepsy : a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response. CURRENT OPINION IN NEUROLOGY. 2018;31(2):198–210.
MLA
Boon, Paul, Elien De Cock, Ann Mertens, et al. “Neurostimulation for Drug-resistant Epilepsy : a Systematic Review of Clinical Evidence for Efficacy, Safety, Contraindications and Predictors for Response.” CURRENT OPINION IN NEUROLOGY 31.2 (2018): 198–210. Print.
@article{8562014,
  abstract     = {Purpose of review: Neurostimulation is becoming an increasingly accepted treatment alternative for patients with drug-resistant epilepsy (DRE) who are unsuitable surgery candidates. Standardized guidelines on when or how to use the various neurostimulation modalities are lacking. We conducted a systematic review on the currently available neurostimulation modalities primarily with regard to effectiveness and safety.
Recent findings: For vagus nerve stimulation (VNS), there is moderate-quality evidence for its effectiveness in adults with drug-resistant partial epilepsies. Moderate-to-low-quality evidence supports the efficacy and safety of deep brain stimulation (DBS) and responsive neurostimulation (RNS) in patients with DRE. There is moderate-to-very low-quality evidence that transcranial direct current stimulation (tDCS) is effective or well tolerated. For transcutaneous vagus nerve stimulation (tVNS), transcranial magnetic stimulation (TMS) and trigeminal nerve stimulation (TNS), there are insufficient data to support the efficacy of any of these modalities for DRE. These treatment modalities, nevertheless, appear well tolerated, with no severe adverse events reported.
Summary: Head-to-head comparison of treatment modalities such as VNS, DBS and RNS across different epileptic syndromes are required to decide which treatment modality is the most effective for a given patient scenario. Such studies are challenging and it is unlikely that data will be available in the near future. Additional data collection on potentially promising noninvasive neurostimulation modalities like tVNS, TMS, TNS and tDCS is warranted to get a more precise estimate of their therapeutic benefit and long-term safety.},
  author       = {Boon, Paul and De Cock, Elien and Mertens, Ann and Trinka, Eugen},
  issn         = {1350-7540},
  journal      = {CURRENT OPINION IN NEUROLOGY},
  keyword      = {deep brain stimulation,drug-resistant epilepsy,neurostimulation,systematic review,vagus nerve stimulation,VAGUS NERVE-STIMULATION,TRANSCRANIAL MAGNETIC STIMULATION,TEMPORAL-LOBE EPILEPSY,RANDOMIZED CONTROLLED-TRIAL,PATIENT OUTCOME REGISTRY,MEDICALLY INTRACTABLE SEIZURES,TERM-FOLLOW-UP,REFRACTORY PARTIAL SEIZURES,FAILED CRANIAL SURGERY,PARTIAL-ONSET EPILEPSY},
  language     = {eng},
  number       = {2},
  pages        = {198--210},
  title        = {Neurostimulation for drug-resistant epilepsy : a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response},
  url          = {http://dx.doi.org/10.1097/WCO.0000000000000534},
  volume       = {31},
  year         = {2018},
}

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