SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Epilepsy
Comparative efficacy of deep brain stimulation in refractory epilepsy with cognitive impairment: a Meta-analysis
Zhejiang Chinese Medical University, Hangzhou, China
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Abstract
Deep brain stimulation (DBS) has been recognized as a promising treatment for drug-resistant epilepsy (DRE); however, its effects on comorbid cognitive impairment remain insufficiently explored. This meta-analysis assessed the effectiveness of DBS in improving cognitive function (including memory, attention, executive function, and processing speed) in DRE patients with concurrent cognitive deficits, while synthesizing evidence on seizure reduction and quality of life (QoL). In accordance with PRISMA guidelines, we analyzed data from 15 prospective studies and randomized controlled trials (RCTs) encompassing 494 participants. Standardized mean differences (SMDs) were computed using a random-effects model, with heterogeneity evaluated via I ² statistics. Results demonstrated significant cognitive improvements across all domains: memory (SMD=2.05, 95% CI: 1.71 – 2.39), attention (SMD=1.36, 95% CI: 1.05–1.67), executive function (SMD=1.67, 95% CI: 1.29– 2.04), and processing speed (SMD=2.09, 95% CI: 1.80–2.38; all p<0.001). Note that SMD values exceeding 2.0 should be interpreted with caution, as they may partly reflect within-subject pre-post designs and regression to the mean rather than solely representing treatment-specific effects. Subgroup analyses indicated that higher stimulation parameters (voltage, pulse width) were associated with enhanced efficacy, though inter-study heterogeneity (I²=60.4–81.0%) highlighted variability in patient characteristics and DBS protocols. The primary sources of heterogeneity include differences in DBS targets (CMN vs. STN), variability in neuropsychological assessment tools, and differences in patient clinical profiles. A further subgroup analysis showed DBS was associated with significant improvements in cognition across memory, attention, executive function, and processing speed. CMN and hippocampus targets yielded the greatest benefits, while STN showed the weakest effects, highlighting target selection's crucial role in optimizing cognitive outcomes. Although DBS exhibits substantial benefits for cognitive impairment and seizure control in DRE, heterogeneity underscores the need for optimized stimulation parameters and standardized cognitive assessments. These findings reinforce the role of DBS as a safe and effective intervention for DRE; however, additional RCTs are necessary to validate long-term outcomes and elucidate underlying mechanisms.
Summary
Keywords
cognitive impairment, DBS, Drug-resistant epilepsy, Meta-analysis, Quality of Life
Received
08 March 2026
Accepted
11 May 2026
Copyright
© 2026 Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wangzhe Du
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