Cochrane · systematic review · CD008497
Deep brain and cortical stimulation for epilepsy
Sprengers, M, Vonck, K, Carrette, E, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
35
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 1 · 2.8%Very low 8 · 22.2%Low 12 · 33.3%Moderate 10 · 27.8%High 5 · 13.9%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyAnterior thalamic nucleus stimulation
Population: adults with IQ > 70 with refractory focal epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) | OR 0.33 [0.01, 8.36] | 1 study · 109 participants | Moderate |
Responder rate (3‐month blinded evaluation period) | OR 1.2 [0.52, 2.8] | 1 study · 108 participants | Moderate |
Seizure frequency reduction (%) (3‐month blinded evaluation period) | no estimate extracted | 1 study · 108 participants | High |
Adverse events | no estimate extracted | 1 study · 109 participants | Moderate |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 96 participants | Moderate |
Quality of life (QOLIE‐31) (3 months) | no estimate extracted | 1 study · 105 participants | High |
Centromedian thalamic nucleus stimulation
Population: patients with refractory (multi)focal or generalized epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) | OR 1 [0.11, 9.39] | 1 study · 6 participants | Very low Downgraded: risk of bias |
Responder rate (3‐month blinded evaluation period) | OR 1 [0.27, 3.69] | 1 study · 6 participants | Very low Downgraded: risk of bias |
Seizure frequency reduction (3‐month blinded evaluation period) | no estimate extracted | 1 study · 6 participants | Very low Downgraded: risk of bias |
Adverse events | no estimate extracted | 2 studies · 19 participants | Low Downgraded: risk of bias |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 6 participants | Very low Downgraded: risk of bias |
Quality of life | no estimate extracted | 0 studies · 0 participants | Ungraded |
Cerebellar stimulation
Population: patients with refractory (multi)focal or generalized epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (1‐ to 3‐month blinded evaluation period) | OR 0.96 [0.22, 4.12] | 3 studies · 22 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Responder rate (1‐ to 3‐month blinded evaluation period) | OR 2.43 [0.46, 12.84] | 3 studies · 19 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Seizure frequency reduction (1‐ to 3‐month blinded evaluation period) | no estimate extracted | 3 studies · 19 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events | no estimate extracted | 3 studies · 22 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Neuropsychological outcome (1 to 2 months) | no estimate extracted | 2 studies · 16 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life (2 months) | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Hippocampal stimulation
Population: patients with refractory medial temporal lobe epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (1‐ to 3‐month blinded evaluation periods) | OR 1.03 [0.21, 5.15] | 3 studies · 15 participants | Moderate Downgraded: risk of bias, imprecision |
Responder rate (1‐ to 3‐month blinded evaluation periods) | OR 1.2 [0.36, 4.01] | 3 studies · 15 participants | Low Downgraded: risk of bias, imprecision |
Seizure frequency (1‐ to 3‐month blinded evaluation periods) | no estimate extracted | 3 studies · 15 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events | no estimate extracted | 3 studies · 15 participants | Low Downgraded: risk of bias, imprecision |
Neuropsychological outcome (1‐ to 3‐month periods) | no estimate extracted | 2 studies · 6 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life (QOLIE‐89) (1‐ to 3‐month periods) | no estimate extracted | 1 study · 3 participants | Very low Downgraded: risk of bias, imprecision |
Nucleus accumbens stimulation
Population: adults with IQ >70 with refractory focal epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) | OR 1 [0.07, 13.64] | 1 study · 4 participants | Low |
Responder rate (3‐month blinded evaluation period) | OR 10 [0.53, 189.15] | 1 study · 4 participants | Low |
Seizure frequency reduction (3‐month blinded evaluation period) | no estimate extracted | 1 study · 4 participants | Low |
Adverse events | no estimate extracted | 1 study · 4 participants | Low |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 4 participants | Low |
Quality of Life (QOLIE‐31‐P) (3 months) | no estimate extracted | 1 study · 4 participants | Low |
Responsive ictal onset zone stimulation
Population: adults with refractory focal epilepsy (1 or 2 epileptogenic regions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) | OR 4.95 [0.23, 104.44] | 1 study · 191 participants | Moderate |
Responder rate (3‐month blinded evaluation period) | OR 1.12 [0.59, 2.11] | 1 study · 191 participants | Moderate |
Seizure frequency reduction (3‐month blinded evaluation period) | no estimate extracted | 1 study · 191 participants | High |
Adverse events | no estimate extracted | 1 study · 191 participants | Moderate |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 160 participants | High |
Quality of life (QOLIE‐89) (3 months) | no estimate extracted | 1 study · 180 participants | High |
Anterior thalamic nucleus stimulation
Population: adults with IQ > 70 with refractory focal epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) | OR 0.33 [0.01, 8.35] | 1 study · 109 participants | Moderate |
Responder rate (3‐month blinded evaluation period) | OR 1.2 [0.52, 2.8] | 1 study · 109 participants | Moderate |
Seizure frequency reduction (%) (3‐month blinded evaluation period) | no estimate extracted | 1 study · 109 participants | High |
Adverse events | no estimate extracted | 1 study · 109 participants | Moderate |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 96 participants | Moderate |
Quality of life (QOLIE‐31) (3 months) | no estimate extracted | 1 study · 105 participants | High |
Centromedian thalamic nucleus stimulation
Population: patients with refractory (multi)focal or generalized epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) | OR 1 [0.11, 9.39] | 1 study · 6 participants | Very low |
Responder rate (3‐month blinded evaluation period) | OR 1 | 1 study · 6 participants | Very low |
Seizure frequency reduction (3‐month blinded evaluation period) | no estimate extracted | 1 study · 6 participants | Very low |
Adverse events | no estimate extracted | 2 studies · 19 participants | Low Downgraded: risk of bias |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 6 participants | Very low |
Quality of life | no estimate extracted | 0 studies · 0 participants | Ungraded |
Cerebellar stimulation
Population: patients with refractory (multi)focal or generalized epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (1‐ to 3‐month blinded evaluation period) | OR 0.96 [0.22, 4.12] | 3 studies · 22 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Responder rate (1‐ to 3‐month blinded evaluation period) | OR 2.43 [0.46, 12.84] | 3 studies · 19 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Seizure frequency reduction (1‐ to 3‐month blinded evaluation period) | no estimate extracted | 3 studies · 19 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events | no estimate extracted | 3 studies · 22 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Neuropsychological outcome (1 to 2 months) | no estimate extracted | 2 studies · 16 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life (2 months) | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Hippocampal stimulation
Population: patients with refractory medial temporal lobe epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (1‐ to 3‐month blinded evaluation periods) | OR 1.03 [0.21, 5.15] | 3 studies · 15 participants | Moderate Downgraded: imprecision |
Responder rate (1‐ to 3‐month blinded evaluation periods) | OR 1.2 [0.36, 4.01] | 3 studies · 15 participants | Low Downgraded: imprecision |
Seizure frequency (1‐ to 3‐month blinded evaluation periods) | no estimate extracted | 3 studies · 15 participants | Moderate Downgraded: imprecision |
Adverse events | no estimate extracted | 3 studies · 15 participants | Low Downgraded: imprecision |
Neuropsychological outcome (1‐ to 3‐month periods) | no estimate extracted | 2 studies · 6 participants | Very low Downgraded: imprecision |
Quality of life (QOLIE‐89) (1‐ to 3‐month periods) | no estimate extracted | 1 study · 3 participants | Very low Downgraded: imprecision |
Responsive ictal onset zone stimulation
Population: adults with refractory focal epilepsy (1 or 2 epileptogenic regions)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (3‐month blinded evaluation period) a | OR 4.95 [0.23, 104.4] | 1 study · 191 participants | Moderate |
Responder rate (3‐month blinded evaluation period) | OR 1.12 [0.59, 2.11] | 1 study · 191 participants | Moderate |
Seizure frequency reduction (3‐month blinded evaluation period) | no estimate extracted | 1 study · 191 participants | High |
Adverse events | no estimate extracted | 1 study · 191 participants | Moderate |
Neuropsychological outcome (3 months) | no estimate extracted | 1 study · 160 participants | High |
Quality of life (QOLIE‐89) (3‐months) | no estimate extracted | 1 study · 180 participants | High |