Background: Approximately thirty percent of epileptic patients have drug-resistant epilepsy (DRE), which severely reduces their quality of life (QoL). Transcutaneous vagus nerve stimulation (t-VNS) has become a noninvasive alternative to invasive vagus nerve stimulation (i-VNS), which has been proven to be a neuromodulatory treatment for seizure reduction. Objective: In this meta-analysis, we investigate the effectiveness of t-VNS in people with DRE by looking at four key outcomes: seizure frequency, responder rate, adverse events, and quality of life.
Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. PubMed, Cochrane, and Scopus were used for literature searches (December 2024). Included were randomized controlled trials (RCTs) that evaluated t-VNS in DRE patients. Reduction in seizure frequency, responder rate (≥50%), adverse events, and quality of life as assessed by the QOLIE-31 and Liverpool Seizure Severity Scale (LSSS) were the outcomes that were examined. Review Manager 5.4.1 was used to perform the meta-analysis, and odds ratios (OR) and standardized mean differences (SMD) were computed.
Results: The inclusion criteria were met by four RCTs with 359 patients. There was no significant difference in responder rates (p=0.16), but the meta-analysis showed a significant decrease in seizure frequency favoring t-VNS (p=0.008). Three studies reported improvements in QoL, but there were no notable differences. Sleep disturbances, lightheadedness, and local discomfort were among the mild to moderate adverse events.
Conclusion: t-VNS demonstrated significant seizure reduction with fewer adverse effects. Further high-quality trials are needed to establish the efficacy of t-VNS.
ISSN-online 2360-2473 / ISSN-print 1223-0472
