Effectiveness of high-frequency vagus nerve stimulation in the treatment of drug-resistant epilepsy: A meta-analysis

doi:10.3969/j.issn.1004-583X.2024.07.002

Abstract

Abstract:

Objective To analyze the efficacy of high-frequency vagus nerve stimulation (VNS) in the treatment of drug-resistant epilepsy (DRE). Methods Randomized controlled trials (RCTs) related to VNS in treating DRE published before September 2023 were independently screened in PubMed, Chinese Biomedical Literature Database (CBM), EMbase, The Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI) and WanFang Data by two researchers. The extracted data were conducted for a Meta analysis using the RevMan5.3 software. Results Nine RCTS representing 918 patients with DRE were included. High-frequency VNS had a higher effective rate for DRE versus drug treatment or low-frequency VNS ( $O R$ =2.30, 95% $C I$ [1.41,3.75], P=0.0009). The results for subgroup analysis showed that the efficacy of high-frequency VNS in Asian and American subgroups grouped by different intercontinental, non-20-week subgroups grouped by different observation cycles, neck VNS subgroups grouped different stimulation sites, and drug treatment subgroups grouped by different treatment regimens were better than those in control subgroups, with statistically significant differences (P<0.05). Conclusion The high-frequency VNS has a good efficacy for DRE.

Key words: epilepsy, vagus nerve stimulation, systematic review, meta analysis, randomized controlled trial

CLC Number:

R742.1

Wang Caizhen, Miao Lina, Chen Yuan, Li Shuangcheng. Effectiveness of high-frequency vagus nerve stimulation in the treatment of drug-resistant epilepsy: A meta-analysis[J]. Clinical Focus, 2024, 39(7): 593-597.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.07.002

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I7/593

Figures/Tables 6

Fig. 1 Process and results of included literature

Tab. 1 Basic data of included literature

纳入研究	国家	例数 (T/C)	年龄 (T/C,岁)	病程 (T/C,年)	干预措施		干预时间 (周)	结局指标
纳入研究	国家	例数 (T/C)	年龄 (T/C,岁)	病程 (T/C,年)	T	C	干预时间 (周)	结局指标
The Vagus Nerve Stimulation Study Group^[7] 1995	美国	54/60	33.1/33.5	23.1/20	20~50 Hz高频迷走神经刺激	1~2 Hz低频迷走神经刺激	14	①
Lötvall et al^[8]1994	美国	31/36	34.2/35.4	23.6/20.7	30 Hz高频迷走神经刺激	1 Hz低频迷走神经刺激	14	①
Bauer^[9]2016	德国	37/39	40.1±12.7/ 37.5±12.2	23±15.4/ 24.2±13.8	25 Hz高频迷走神经刺激	1 Hz低频迷走神经刺激	20	①
Pressler et al^[10] 2012	荷兰	21/20	11(3-4)/ 11(4-17)	2(0-12)/ 1(0-5)	30 Hz高频迷走神经刺激	1 Hz低频迷走神经刺激	20	①
Handforth et al^[11]1998	美国	94/102	32.1±10.8/ 34.2±10.1	22.1±11.5/ 23.7±10.8	30 Hz高频迷走神经刺激	1 Hz低频迷走神经刺激	14	①
李莉莉^[12]2019	中国	50/40	29.12±6.61/ 29.09±6.73	11.12±5.06/ 11.05±5.12	20~30 Hz高频迷走神经刺激	安慰刺激	24	①
荣培晶等^[13]2013	中国	98/46	24.44±12.13/ 22.20±15.44	12.81±9.05/ 11.36±11.05	20~30 Hz高频迷走神经刺激	安慰刺激	24	①
于天宇2013^[14]	中国	45/45	14.8±1.6/ 14.4±1.5	5.8±1.2/ 5.3±1.1	20~30 Hz高频迷走神经刺激	药物治疗	4	①
蔡鸣凡等^[15]2015	中国	50/50	23±5/ 24±6	5.8±1.5/ 5.2±1.4	20~30 Hz高频迷走神经刺激	药物治疗	48	①

Tab. 2 Risk of bias assessment of included literature

纳入研究	随机方法	分配隐藏	盲法	结果数据完整性	选择性报告研究结果	其他偏倚来源
The vagus nerve stimulation study group^[7] 1995	不清楚	不清楚	双盲	完整	无	不清楚
Lötvall et al^[8] 1994	不清楚	不清楚	双盲	完整	无	不清楚
Bauer et al^[9]2016	不清楚	不清楚	双盲	有失访(ITT)	无	不清楚
Pressler et al^[10] 2012	不清楚	不清楚	双盲	完整	无	不清楚
Handforth et al^[11]1998	不清楚	不清楚	双盲	有失访	无	不清楚
李莉莉^[12] 2019	不清楚	不清楚	不清楚	完整	无	不清楚
荣培晶等^[13] 2013	中心电话随机	不清楚	双盲	有失访	无	不清楚
于天宇^[14] 2013	不清楚	不清楚	不清楚	完整	无	不清楚
蔡鸣凡等^[15] 2015	不清楚	不清楚	不清楚	完整	无	不清楚

Fig. 2 Meta-analysis for the efficacy of high-frequency VNS for DRE

Tab. 3 Meta-analysis for the efficacy of high-frequency VNS for DRE in the subgroups

亚组	纳入研究数	异质性检验结果		效应模型	Meta分析结果
亚组	纳入研究数	P值	$I 2$	效应模型	效应量(95% $C I$ )	P值
洲际分布
亚洲	4^{[12⇓⇓-15]}	0.03	66%	随机	3.53(1.58,7.88)	0.002
欧洲	2^[9-10]	0.81	0%	固定	0.80(0.35,1.83)	0.59
美洲	3^[7-8,11]	0.57	0%	固定	2.16(1.30,3.57)	0.003
观察时间
4周	1^[14]	-	-	随机	-	-
14周	3^[7-8,11]	0.57	0%	固定	2.16(1.30,3.57)	0.003
20周	2^[9-10]	0.81	0%	固定	0.80(0.35,1.83)	0.59
24周	2^[12-13]	0.35	0%	固定	2.06(1.16,3.66)	0.01
48周	1^[15]	-	-	随机	-	-
不同刺激部位
经耳迷走神经刺激	2^[12-13]	0.35	0%	固定	2.06(1.16,3.66)	0.01
颈部迷走神经刺激	7^{[7⇓⇓⇓-11,14,15]}	0.008	65%	随机	2.35(1.21,4.54)	0.01
对照组治疗方案
安慰剂刺激	5^{[7⇓⇓⇓-11]}	0.26	24%	随机	1.57(0.94,2.63)	0.08
药物治疗	4^{[12⇓⇓-15]}	0.03	66%	随机	3.53(1.58,7.88)	0.002

Tab. 3 Meta-analysis for the efficacy of high-frequency VNS for DRE in the subgroups

亚组	纳入研究数	异质性检验结果		效应模型	Meta分析结果
亚组	纳入研究数	P值	$I 2$	效应模型	效应量(95% $C I$ )	P值
洲际分布
亚洲	4^{[12⇓⇓-15]}	0.03	66%	随机	3.53(1.58,7.88)	0.002
欧洲	2^[9-10]	0.81	0%	固定	0.80(0.35,1.83)	0.59
美洲	3^[7-8,11]	0.57	0%	固定	2.16(1.30,3.57)	0.003
观察时间
4周	1^[14]	-	-	随机	-	-
14周	3^[7-8,11]	0.57	0%	固定	2.16(1.30,3.57)	0.003
20周	2^[9-10]	0.81	0%	固定	0.80(0.35,1.83)	0.59
24周	2^[12-13]	0.35	0%	固定	2.06(1.16,3.66)	0.01
48周	1^[15]	-	-	随机	-	-
不同刺激部位
经耳迷走神经刺激	2^[12-13]	0.35	0%	固定	2.06(1.16,3.66)	0.01
颈部迷走神经刺激	7^{[7⇓⇓⇓-11,14,15]}	0.008	65%	随机	2.35(1.21,4.54)	0.01
对照组治疗方案
安慰剂刺激	5^{[7⇓⇓⇓-11]}	0.26	24%	随机	1.57(0.94,2.63)	0.08
药物治疗	4^{[12⇓⇓-15]}	0.03	66%	随机	3.53(1.58,7.88)	0.002

Fig. 3 Funnel plot for high-frequency VNS for DRE

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