高频迷走神经刺激治疗难治性癫痫有效性的meta分析

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

目的分析高频迷走神经刺激(vagus nerve stimulation,VNS)治疗药物难治性癫痫的疗效。方法计算机检索PubMed、CBM、EMbase、The Cochrane Library、Web of Science、CNKI和WanFang Data数据库,由2名研究者独立搜索有关迷走神经刺激治疗药物难治性癫痫的随机对照试验(RCT),检索时限均为建库至2023年9月,筛选出相关RCT,并提取资料,采用RevMan5.3软件进行meta分析。结果共纳入9个RCT,包括918例药物难治性癫痫患者。分析结果显示,与药物和低频迷走神经刺激相比,高频迷走神经刺激治疗难治性癫痫的有效率更高[OR=2.30,95%CI(1.41,3.75),P=0.0009]。亚组分析结果显示不同洲际中的亚洲和美洲、不同观察周期中非20周亚组、不同刺激部位、不同对照组治疗方案等亚组的高频迷走神经刺激治疗效果均优于对照组,差异均具有统计学意义。结论高频迷走神经刺激治疗药物难治性癫痫能取得较好疗效。

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(OR=2.30,95%CI[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.