Assessing the efficacy and safety of transcranial magnetic stimulation and vagus nerve stimulation for drug-resistant epilepsy: A systematic review

Background: Drug-resistant epilepsy (DRE), characterized by inadequate seizure control despite adequate trials of multiple antiepileptic medications, affects a substantial proportion of the global epilepsy population. Recent advances in neuromodulation techniques have demonstrated promise as adjunctive therapeutic approaches for managing treatment-resistant epilepsy. Transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) represent emerging interventions for patients who fail conventional pharmacological management. Methods: A comprehensive search was performed for multiple databases such as PubMed, Cochrane Library, and Google Scholar. Search was done for studies from 1995 to 2024, which will meet our inclusion criteria and exclusion criteria. We selected 36 studies that include randomized controlled trials, observational studies, and retrospective analyses. Our primary outcome is seizure recurrence, and the secondary outcomes are adverse events. Our systematic review is registered in PROSPERO, and its ID is CRD42025629381. Results: Approximately 47% of patients treated with either TMS or VNS were found to have a mean seizure reduction of over 50%, which also contributed to the results of our data interpretation. Even in several institutional studies, it was additionally found that more than 60% of patients showed significant improvements in seizure control. Conclusion: Evidence reported that both TMS and VNS greatly improve seizure control in patients with drug-resistant epilepsy, potentially enhancing quality of life and reducing seizure frequency. A large amount of our findings support the integration of neuromodulation techniques into future treatment regimens for drug-resistant epilepsy, which might be accompanied by calls for future clinical trials.