Assessing Short-Term and Long-Term Security and Efficacy of Anterior Nucleus of Thalamus Deep Brain Stimulation for Treating Drug-Resistant Epilepsy: A Systematic Review and Single-Arm Meta-Analysis

Introduction: Deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) is a known invasive procedure used for treating refractory epilepsy. However, there is no solid evidence in the literature regarding the short-term and long-term efficacy and safety of ANT-DBS. Hence, we performed a systematic review and meta-analysis.

Methods: We searched PubMed, Cochrane, Embase, and Web of Science for studies treating refractory epilepsy with ANT-DBS, following PRISMA guidelines. Short-term group was constituted of studies with a mean follow-up of 3 years or less. The outcomes assessed for data extraction were: procedure responders and nonresponders, increased seizure frequency, complications, and procedure-related mortality.

Results: Among 650 studies, 25 fit our inclusion criteria, involving 427 patients. Prior surgical treatments have been reported in 214 (50.1%) patients, and the median average baseline seizure frequency was 64.9 monthly seizures. In the short-term analysis, we spotted a proportion of 67% (95% CI: 54% - 79%) of responders and 33% (95% CI: 21% - 46%) of nonresponders. Moreover, 4% (95% CI: 0% - 9%) of the patients presented increased seizure frequency. Finally, short-term depression was seen in 12% of cases (95% CI: 1% - 23%). In contrast, within the long-term group, we observed 72% (95% CI: 66% - 78%) of responders and 27% (95% CI: 21% - 34%) nonresponders. Additionally, there was a 2% (95% CI: 0% - 5%) increase in seizure frequency. The proportion of long-term depression was 36% (95% CI: 0% - 86%). No procedure-related mortality was reported in this study.

Conclusion : ANT-DBS is viable for drug-resistant epilepsy, with lasting short-term and long-term improvements. It remains safe and efficient despite complications, showing no procedure-linked fatalities, high patient responsiveness, minimal increased seizures and consistent results over time and low morbidity/mortality rates over time. Further research is necessary to diminish the discrepancy among results.