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dc.contributor.authorBatson, S
dc.contributor.authorShankar, R
dc.contributor.authorConry, J
dc.contributor.authorBoggs, J
dc.contributor.authorRadtke, R
dc.contributor.authorMitchell, S
dc.contributor.authorBarion, F
dc.contributor.authorMurphy, J
dc.contributor.authorDanielson, V
dc.date.accessioned2022-01-17T23:48:45Z
dc.date.available2022-01-17T23:48:45Z
dc.date.issued2022-06
dc.identifier.issn0340-5354
dc.identifier.issn1432-1459
dc.identifier.urihttp://hdl.handle.net/10026.1/18569
dc.description.abstract

<jats:title>Abstract</jats:title><jats:p>Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) for the management of adults with DRE. A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print, Embase, and the Cochrane library databases. Outcomes examined included reduction in seizure frequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs). Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy. Four RCTs and six comparative observational studies were identified for inclusion. Against comparators, individuals treated with VNS had a significantly better odds of experiencing a ≥ 50% reduction in seizure frequency (OR: 2.27 [95% CI 1.47, 3.51]; <jats:italic>p</jats:italic> = 0.0002), a ≥ 75% reduction in seizure frequency (OR: 3.56 [95% CI 1.59, 7.98]; <jats:italic>p</jats:italic> = 0.002) and a reduced risk for increased ASM load (risk ratio: 0.36 [95% CI 0.21, 0.62]; <jats:italic>p</jats:italic> = 0.0002). There was no difference in the odds of discontinuation or the rate of SAEs between VNS versus comparators. This meta-analysis demonstrated the benefits of VNS Therapy in people with DRE, which included improvement in seizure frequency without an increase in the rate of SAEs or discontinuations, thereby supporting the consideration of VNS Therapy for people who are not responding to ASMs and those unsuitable or unwilling to undergo surgery.</jats:p>

dc.format.extent2874-2891
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectAnti-seizure medication
dc.subjectVNS therapy
dc.subjectMeta-analysis
dc.subjectDrug-resistant epilepsy
dc.subjectSeizure frequency
dc.titleEfficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis
dc.typejournal-article
dc.typeReview
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/35034187
plymouth.issue6
plymouth.volume269
plymouth.publisher-urlhttp://dx.doi.org/10.1007/s00415-022-10967-6
plymouth.publication-statusPublished
plymouth.journalJournal of Neurology
dc.identifier.doi10.1007/s00415-022-10967-6
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Users by role
dc.publisher.placeGermany
dcterms.dateAccepted2022-01-06
dc.rights.embargodate9999-12-31
dc.identifier.eissn1432-1459
dc.rights.embargoperiodNot known
rioxxterms.versionofrecord10.1007/s00415-022-10967-6
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
rioxxterms.licenseref.startdate2022-01-16
rioxxterms.typeJournal Article/Review


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