Table 1.

Indication, effectiveness, and adverse effects in VNS, RNS, and ANT‐DBS

	VNS	RNS	ANT‐DBS
Indication	VNS is indicated for symptomatic localization–related epilepsy with multiple and bilateral independent foci, symptomatic generalized epilepsy with diffuse epileptogenic abnormalities, refractory idiopathic generalized epilepsy, failed intracranial epilepsy surgery, and other several reasons of contraindications to epilepsy surgery	Adults with partial‐onset seizures who have undergone diagnostic testing that localized no more than 2 epileptogenic foci and refractory to two or more antiepileptic medications, and currently have frequent and disabling seizures (motor partial seizures, complex partial seizures, and/or secondarily generalized seizures)	Bilateral stimulation of the anterior nucleus of the thalamus (ANT) for epilepsy is indicated as an adjunctive therapy for reducing the frequency of seizures in individuals 18 y of age or older diagnosed with epilepsy characterized by partial‐onset seizures with or without secondary generalization that are refractory to three or more antiepileptic medications
Effectiveness	Seizure frequency was reduced by an average of 45%, with a 36% reduction in seizures at 3‐12 mo after surgery and a 51% reduction after >1 y of therapy. At the last follow‐up, seizures were reduced by 50% or more in approximately 50% of the patients, and VNS predicted a ≥50% reduction in seizures with a main‐effects OR of 1.83	The average decrease in seizures was 44% after 1 y, 53% at 2 y, and up to 66% after 3‐6 y of using RNS. The same trend was seen when some of these people were followed for 7 y. Seizures decreased by an average of 72%	Seizures decreased on average after 3 mo by 40% in people treated with DBS as compared to only 15% for those in a placebo group (not receiving DBS). People receiving DBS for long‐term follow‐up (up to 7 y) had seizures decreased by 75%
Adverse effects	Common side effects are cough, hoarseness, voice alteration, and paresthesia. These side effects tend to diminish with time. Cognitive side effects often seen with antiepileptic drug use are not reported	Serious adverse events occurring in ≥2.5% of patients include EEG monitoring, infection, change in seizures, medical device removal, death, device lead damage or revision, antiepileptic drug toxicity, hemorrhage, psychiatric events, status epilepticus, and seizure‐related injury. Refer to the product labeling for a detailed disclosure of other reported adverse events	Serious adverse events (SAEs) accounted for 5.9% of events and device‐related SAEs were 1.7% of all events. A serious device‐related adverse event was reported in 34.5% (38/110) of subjects. There were no unanticipated adverse device effects, including death, intracranial hemorrhage, device‐related infection, and neuropsychological problem