Etns for Drug Resistant Epilepsy: A Systematic Review

Introduction: Trigeminal Nerve Stimulation (TNS) is an emerging technique that can be used to reduce seizure burden in drug-resistant epilepsy (DRE), but its efficacy is not well characterized. This study sought to understand the application of trigeminal nerve stimulation (TNS) in drug resistant epilepsy (DRE) by providing a comprehensive overview of the current use and efficacy of TNS for neuromodulation in DRE, given its emerging and limited adoption in this arena.

Methods: A systematic review examining the use of TNS for DRE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, and Embase databases were queried; studies were included if they examined TNS for treatment of DRE in human patients and reported seizure outcomes. Demographic, clinical, TNS neurostimulation parameters, and outcome data were collected. Primary outcome measures included efficacy, measured by change in seizure frequency, and adverse events (AEs). Secondary outcomes included patient-reported metrics assessing quality of life (QoL).

Results: A total of 234 studies were identified; seven met inclusion criteria, comprising a total of 148 patients. Seizure history and epilepsy characteristics varied. Mean age ranged 28.8-44.26 years, with percent male ranging 7-24%. All studies reporting seizure frequency showed a significant reduction in seizure frequency following TNS, though follow-up time varied. Adverse events included skin irritation and headache most commonly, reported at 12% and 11%, respectively. No serious or life-threatening adverse effects were reported. Multiple studies reported positive changes in Beck Depression Inventory (BDI) and Quality of Life in Epilepsy (QOLIE) scores indicating an increase in quality of life and mood throughout treatment periods.

Conclusion : TNS is an emerging, though not widely adopted, neuromodulation applied in DRE. Our review suggests it is well-tolerated and can reduce seizure frequency, while improving mental health and well-being, with minimal AEs. Larger comparative studies are needed to better explore the use of TNS for treatment of DRE.