Neuromodulation for drug-resistant epilepsy is associated with modest improvements in depression and quality of life without meaningful cognitive deterioration over follow-up durations of 6 months to 14 years.
Thalamic neuromodulation using DBS and RNS was safe and well tolerated in pediatric patients with DRE, including multifocal and generalized seizure onsets, with a trend toward greater benefit in the DBS group.
Dominic Nistal, Benjamin D. Edmonds, Adriel Barrios-Anderson et al.· Journal of Neurosurgery: Ped...· 0 citations
Background: Disorders of consciousness (DoC) have limited effective therapies. Implantable vagus nerve stimulation (VNS) is established for epilepsy but remains underexplored for DoC with comorbid epilepsy. Objectives: To evaluate whether VNS is associated with improved consciousness recovery in DoC patients with epilepsy and to explore factors related to response. Design: Retrospective propensity score-matched cohort study. Methods: Ninety DoC patients with epilepsy received implantable VNS or conservative management. The primary outcome was clinically meaningful improvement at 1 year (Coma Recovery Scale-Revised (CRS-R) increase ⩾3 points). Propensity score matching (1:1) balanced baseline characteristics (23 per group). Longitudinal CRS-R trajectories were assessed using linear mixed-effects models with Type III ANOVA. Logistic regression within the VNS cohort explored factors associated with responder status; adverse events were extracted from operative and follow-up records. Results: The 1-year responder rate was higher with VNS than with conservative management (34.78% vs 4.35%; two-sided Fisher’s exact test, p = 0.022). Longitudinal analyses showed a significant group × time interaction (χ2 = 43.535, p < 0.001) with greater CRS-R gains from 3 months onward in the VNS group. Within the VNS cohort, responder status was associated with baseline minimally conscious state (aOR = 9.750, 95% confidence interval (CI) 1.592–59.695; p = 0.014) and better seizure control (McHugh classification; aOR = 22.667, 95% CI 3.140–163.629; p = 0.002). Traumatic etiology was not associated with 12-month net CRS-R improvement after adjustment for baseline CRS-R (β = 0.893, 95% CI −1.583 to 3.369; p = 0.466). Five patients reported stimulation-related hoarseness/dysphonia, and two had surgical-site complications; no device removal occurred. Conclusion: Implantable VNS was associated with higher 1-year clinically meaningful improvement and greater longitudinal CRS-R gains than conservative management in DoC patients with epilepsy. Prospective controlled studies are warranted.
J. Zuo, K. Ma, Zizhang Cheng et al.· Therapeutic Advances in Neur...· 0 citations
Objective
Post-stroke depression (PSD) is a common neuropsychiatric complication after stroke and is associated with poorer functional recovery and quality of life. This systematic review and meta-analysis evaluated the efficacy and safety of non-invasive brain stimulation (NIBS), specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), for PSD.
Methods
PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched from inception to April 2025. Randomized controlled trials comparing rTMS or tDCS with sham stimulation, placebo, usual care, or other control interventions in adults with PSD were eligible. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for depressive symptoms and secondary outcomes. Fixed- or random-effects models were selected according to heterogeneity.
Results
Seventeen randomized controlled trials involving 917 participants were included. Compared with control interventions, NIBS was associated with a greater reduction in depressive symptoms (SMD = -1.24, 95% CI: -1.74 to -0.73, p < 0.001). Subgroup analyses showed significant effects for both rTMS (SMD = -1.06, 95% CI: -1.59 to -0.52) and tDCS (SMD = -1.94, 95% CI: -3.25 to -0.63), although the difference between modalities was not statistically significant. High-frequency rTMS showed a numerically larger effect than low-frequency rTMS, but the subgroup difference was not significant. NIBS was also associated with improvements in activities of daily living (SMD = 0.80) and quality of life (SMD = 0.83). No serious stimulation-related adverse events were reported.
Conclusion
Current randomized evidence suggests that rTMS and tDCS may improve depressive symptoms in patients with PSD and appear generally well tolerated. However, the certainty of these findings is limited by substantial heterogeneity, small sample sizes in several trials, and variation in stimulation protocols. Further well-designed trials are needed to define optimal stimulation parameters, treatment timing, and long-term clinical effects.
Pei-Zhang Huang, Hao-Jie Wang, Chen Huang et al.· Frontiers in Psychology· 0 citations
Background Deep brain stimulation (DBS) has emerged as a palliative neurosurgical treatment option for drug-resistant epilepsy (DRE), particularly in patients who are not candidates for resective surgery or who continue to experience seizures after surgical intervention. Multiple thalamic and extrathalamic targets have been investigated; however, optimal target selection remains challenging and requires a comprehensive understanding of epileptogenic networks. Objective To provide a comprehensive overview of current evidence on DBS for DRE and refractory status epilepticus, with a focus on anatomical targets, mechanisms of action, clinical outcomes, and considerations for target selection. Methods We reviewed the existing literature on DBS in epilepsy, including randomized controlled trials, observational studies, meta-analyses, and relevant experimental data. Major targets—including the anterior nucleus of the thalamus (ANT), centromedian nucleus (CM), pulvinar, mediodorsal nucleus (DM), subthalamic nucleus (STN), and other emerging targets—were examined in terms of connectivity, proposed mechanisms, and clinical efficacy. Results Among available targets, ANT-DBS has the strongest clinical evidence, demonstrating sustained seizure reduction in randomized trials and long-term follow-up studies. CM-DBS shows particular promise in generalized epilepsy, especially Lennox–Gastaut syndrome, likely through modulation of thalamocortical and reticular networks. The pulvinar has emerged as a potential target for temporal and posterior quadrant epilepsies, reflecting its extensive cortical connectivity. Other targets, including the DM, STN, hippocampus, hypothalamus, nucleus accumbens, and cerebellum, have shown variable efficacy in smaller studies and may be relevant for specific epilepsy subtypes or network configurations. Across targets, therapeutic effects are likely mediated by modulation of distributed epileptogenic networks involving limbic, sensorimotor, and arousal systems. Conclusion DBS represents an important therapeutic option for DRE, expanding the scope of neuromodulation beyond traditional surgical approaches. Optimal outcomes depend on individualized target selection based on seizure semiology, network characteristics, and anatomical considerations. As clinical experience and technological advances continue to evolve, further studies are required to refine patient selection, improve targeting strategies, and optimize stimulation paradigms.
Ryota Sasaki, Masako Kinoshita, Abbas F. Sadikot et al.· Frontiers in Neurology· 0 citations
Essential tremor (ET) is a common movement disorder; its management remains challenging despite the availability of multiple treatment options. Pharmacological therapies are often limited in efficacy and tolerability, while surgical options, although effective, are invasive and expensive. Peripheral nerve stimulation (PNS) has emerged as a non-invasive neuromodulation approach. However, different stimulation protocols, small samples, and inconsistent outcome reporting preclude firm conclusions. Therefore, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of PNS for ET. A literature search was conducted through PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases till January 2026. The primary outcome was the change in tremor intensity, as measured by the TETRAS Performance Scale (TETRAS-PS). Secondary outcomes included functional disability, assessed by the Bain and Findley Activities of Daily Living (BF-ADL) scale, clinical improvement assessed using the clinical global impression – improvement (CGI-I) scale, as well as safety outcomes. Quality assessment was performed using the Risk of Bias-2 (RoB-2) and the NIH single-arm tools. Certainty of evidence was assessed using GRADE approach. A meta-analysis was performed, calculating the mean difference (MD) with 95% confidence intervals (CIs) using Review Manager 5.4.1. Twelve studies, involving 914 participants, met the inclusion criteria, including four RCTs. Our analysis of RCTs demonstrated that active PNS produced a statistically significant reduction in tremor intensity (TETRAS-PS; MD=-0.92, 95%CI [-1.63 to -0.21], P = 0.01, I2 = 0) and an improvement in functional outcomes (BF-ADL; MD=-1.90, 95%CI [-2.97 to -0.83], p = 0.0005, I2 = 0). Benefits were observed immediately and persisted for up to three months in longitudinal studies. Adverse events were generally mild and limited mainly to transient skin irritation; no device-related serious adverse events were reported. PNS was associated with short-term reduction in tremor severity and functional impairment in patients with ET, with an overall acceptable safety profile, suggesting that it may serve as a middle ground option between pharmacotherapy and invasive neurosurgical approaches. However, further larger and longer randomized trials with refined sham controls are needed to confirm its efficacy, durability, and optimize stimulation strategies. CRD420261282826.
Mark Messak, Y. Omar, Nada Mosad et al.· Neurosurgical review· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
