Journal of Neurology
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Published By Springer-Verlag

1432-1459, 0340-5354

Sarah Batson ◽  
Rohit Shankar ◽  
Joan Conry ◽  
Jane Boggs ◽  
Rodney Radtke ◽  

AbstractVagus 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.

Roberto Bergamaschi ◽  
Giulia Mallucci ◽  
Sara Fusco ◽  
Cristina Montomoli

Andrea Sturchio ◽  
Alok K. Dwivedi ◽  
Matteo Gastaldi ◽  
Maria Barbara Grimberg ◽  
Pietro Businaro ◽  

Xiang Huang ◽  
Junyu Lin ◽  
Huifang Shang ◽  
Jing Yang

Berno U. H. Overbeek ◽  
Jan C. M. Lavrijsen ◽  
Simon van Gaal ◽  
Daniel Kondziella ◽  
Henk J. Eilander ◽  

Alessandra Morano ◽  
Emanuele Cerulli Irelli ◽  
Martina Fanella ◽  
Biagio Orlando ◽  
Enrico Michele Salamone ◽  

Alvaro Cobo-Calvo ◽  
Ana Zabalza ◽  
Jordi Río ◽  
Georgina Arrambide ◽  
Susana Otero-Romero ◽  

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