Wzorce czasowe skuteczności neurostymulacji w epilepsji opornej na leki: przegląd systematyczny i metaanaliza
Temporal patterns of neurostimulation efficacy in drug-resistant epilepsy: A systematic review and meta-analysis
W skrócie
Badanie porównało cztery rodzaje urządzeń do stymulacji mózgu (stymulacja nerwu błędnego, głęboka stymulacja mózgu i inne) używane u pacjentów z epilepsją, która nie reaguje na leki. Wyniki pokazały, że wszystkie urządzenia działają coraz lepiej w miarę upływu czasu - po 3 miesiącach pomaga u 39% pacjentów, a po 2 latach u 63% pacjentów. Różnice między typami urządzeń były mniej ważne niż fakt, że każde z nich potrzebuje czasu, aby działać skutecznie, a najlepsze efekty widać dopiero po roku lub dłużej.
Oryginalny abstract (angielski)
OBJECTIVE: To systematically evaluate the temporal efficacy trajectories and relative performance of four neurostimulation modalities (open-loop Vagus Nerve Stimulation [ol-VNS], closed-loop VNS [cl-VNS], Deep Brain Stimulation [DBS], and Responsive Neurostimulation [RNS]) in patients with drug-resistant epilepsy (DRE). METHODS: Following PRISMA guidelines, PubMed, Cochrane Library, and Web of Science were searched for studies published during the modern neuromodulation era (2014-2024). We included original studies of patients without prior resective surgery who received single-device implantation. Data were mapped into four standardized follow-up windows (3, 6, 12-18, and ≥21 months). Pooled responder rates (RRs, ≥50% seizure reduction) were calculated using a random-effects model. A mixed-effects meta-regression was conducted to explore the interaction between device modality and time. RESULTS: A total of 95 unique cohorts were included. Overall pooled responder rates (RRs) demonstrated a robust, time-dependent improvement: 39% (95% CI: 30%-48%) at 3 months, 48% (95% CI: 42%-53%) at 6 months, 58% (95% CI: 55%-61%) at 12-18 months, and peaking at 63% (95% CI: 58%-67%) at ≥21 months. Meta-regression (Q = 94.13, p < 0.0001) confirmed a highly significant main effect for follow-up duration. While numerical differences existed among devices-with cl-VNS, DBS, and RNS showing higher overall efficacy baselines compared to ol-VNS-the interaction terms between device type and follow-up duration were universally non-significant (all p > 0.05), indicating that the current data do not provide statistical evidence of diverging temporal trajectories across modalities. SIGNIFICANCE: Across all modalities, neurostimulation produced a robust, time-dependent improvement in responder rates, with progressive gains consolidating over 1 to 2 years. This temporal pattern is consistent with the hypothesis of delayed network remodeling, though the present data cannot confirm a shared mechanism. Numerical differences in baseline responder rates across devices are more likely attributable to patient selection and indication bias than to intrinsic hardware superiority.