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Review
. 2024 Oct 13;16(10):e71348.
doi: 10.7759/cureus.71348. eCollection 2024 Oct.

Assessment of the Efficacy of Deep Brain Stimulation (DBS) in Managing Drug-Resistant Epilepsy (DRE): A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)

Elshymaa E Raslan  1 , Sultan F Al-Hawas  2 , Moaath M Alghamdi  3 , Abdalrhman S Alblwan  4 , Anas Alhomaidhi  5 , Abdulaziz A Alruwaili  6 , Rabah Warar  7 , Atheer S Alhwaiti  8 , Rakan M Alsubhi  9 , Wafa F Al-Harbi  10 , Majd Nouh Alasmari  11
Affiliations
Review

Assessment of the Efficacy of Deep Brain Stimulation (DBS) in Managing Drug-Resistant Epilepsy (DRE): A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)

Elshymaa E Raslan et al. Cureus. .

Abstract

Epilepsy is a chronic neurological disorder affecting millions of people around the world. Even though the majority of patients gain seizure control with antiseizure medications (ASMs), many subjects may have drug-resistant epilepsy (DRE). Deep brain stimulation (DBS) is a promising alternative, showing effectiveness in reducing seizures for some patients. This systematic review and meta-analysis aim to evaluate DBS's efficacy in DRE. A comprehensive search in PubMed, CENTRAL, Medline, Ovid, and Scopus was performed up to August 31, 2024, using the terms 'Drug-resistant Epilepsy' AND 'Deep Brain Stimulation'. Two independent researchers screened titles, abstracts, and full texts. The data extracted included study details, sample size, age at surgery, seizure duration, follow-up duration, seizure reduction (SR), responder rate (RR), and adverse events. Quality assessment was conducted using the Risk of Bias 2 (ROB2) tool (https://methods.cochrane.org/bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials), and data analysis was performed using Jamovi software (https://www.jamovi.org). The search yielded 707 studies that were initially screened. Out of them, 29 articles were retrieved for full-text screening, and 5 randomized controlled trials (RCTs) were included in the review and meta-analysis. The meta-analysis showed that the pooled effect size for SR was 0.51 (95% CI, 0.35-0.68; P < 0.001), and the pooled effect size for RR was 0.54 (95% CI, 0.35-0.74; P < 0.001), demonstrating significant improvements in seizure control. The pooled effect size for adverse events was 0.21 (95% CI, 0.08-0.34; P = 0.001). The risk-of-bias assessment revealed a low risk of randomization for most studies. However, concerns were noted in areas such as deviations from the intended intervention and missing outcome data. In conclusion, DBS is a viable intervention for DRE, with significant reductions in seizure frequency and a favorable safety profile. However, the variability in efficacy and RRs across studies underscores the need for continued research to refine patient selection criteria, optimize stimulation parameters, and explore the differential effects of targeting various thalamic nuclei.

Keywords: deep brain stimulation; drug-resistant epilepsy; meta-analysis; responder rate; seizure reduction.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart selection process
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Meta-analysis of the seizure reduction (SR)
Forest plot showing the pooled effect sizes for seizure reduction (SR) among patients treated with deep brain stimulation (DBS). The pooled effect size was 0.51 (95% CI, 0.35–0.68), indicating a moderate effect. Significant heterogeneity was detected (I² = 93.88%, p < 0.001), and the restricted maximum likelihood model was used for the analysis. Source: [15-19]
Figure 3
Figure 3. Meta-analysis of responder rate (RR)
Forest plot showing the pooled effect sizes for responder rate (RR) among patients treated with deep brain stimulation (DBS). The pooled effect size was 0.54 (95% CI, 0.35–0.74), indicating a significant treatment effect. Significant heterogeneity was detected (I² = 95.87%, p < 0.001), and the restricted maximum likelihood model was used for the analysis. Source: [15-19]
Figure 4
Figure 4. Meta-analysis of adverse events
Forest plot showing the pooled effect sizes for adverse events (AE) among patients treated with deep brain stimulation (DBS). The pooled effect size was 0.21 (95% CI, 0.08–0.34), indicating a low incidence of AEs. Significant heterogeneity was detected (I² = 88.29%, p < 0.001), and the restricted maximum likelihood model was used for the analysis. Source: [15-17]
Figure 5
Figure 5. Risk-of-bias traffic light plot
Source: [15-19]
Figure 6
Figure 6. Risk-of-bias summary
See this image and copyright information in PMC

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