2024 American Academy of Neurology Abstract Website

Yousef Hawas¹, Ibraheem Alkhawaldeh², Hamza Alsalhi³, Rafi Matin⁴, George Ibrahim⁵, Ahmed Negida⁶
¹Faculty of Medicine, Tanta University, Gharbeya, Egypt, ²Faculty of Medicine, Mutah University, Al-Karak-Jordan, ³Faculty of Medicine, The Hashemite University, Zarqa, Jordan, ⁴University of Toronto & SickKids Research Institute, Ontario, Canada, ⁵Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada, ⁶Virginia Commonwealth University, Virginia, USA

Objective:

Through an updated review of randomized controlled trials, this meta-analysis aims to provide a comprehensive examination of the safety and efficacy of transcranial direct current stimulation (tDCS) in patients with refractory epilepsy.

Background:

Approximately one-third of epilepsy patients continue to experience seizures despite the currently available treatment. tDCS has emerged as a potential neuromodulation approach for the non-invasive treatment of refractory epilepsy.

Design/Methods:

Following the PRISMA guidelines, PubMed, Ovid MEDLINE, Embase, EBSCO, Scopus, Cochrane Central, and WOS (Web of Science) were searched from inception until June 2023 to identify relevant RCTs. Search results were compiled in Rayyan. Data were extracted and analyzed with RevMan web software. Variables such as electrodes location, current intensity, number of sessions, duration of stimulation, frequency and duration of epilepsy, and complications were extracted. Pooled mean difference was calculated for change in seizure frequency (SF), and number of Interictal epileptiform discharge (IED) at four and eight weeks. Cochrane ROB-II was used to assess the quality of the included studies.

Results:

Eight RCTs were included with a total of 242 patients. Compared to the sham group, tDCS patients had a significantly lower seizure frequency at four and eight weeks of follow-up (MD= -4.72, 95% CI [-6.80, -2.65] P < 0.05) and (MD = -3.39, 95% CI [-6.07, -0.72], P < 0.05), respectively. The IED was observed to decline at four weeks of follow-up (MD = -5.35, 95% CI [-7.70, -2.99], P < 0.05). The reported adverse events were not serious. It includes only mild itching and erythematous rash that resolved spontaneously.

Conclusions:

It was found that tDCS significantly reduced SF and the number of IED. However, there was a heterogeneity in the SF at eight weeks of follow-up. Future large RCTs are needed with a standard clear informed stimulation protocol to further promote tDCS therapy in the management of refractory epilepsy.