Efficacy and safety of transcranial direct current stimulation (tDCS) in treatment of refractory epilepsy: an updated systematic review and meta-analysis of randomized sham-controlled trials

Despite the currently available treatment, one-third of epilepsy patients continue to experience seizures. Transcranial direct current stimulation (tDCS) has emerged as a potential neuromodulation approach for the non-invasive treatment of refractory epilepsy. This study aims to provide a comprehensive investigation of the efficacy and safety of tDCS in patients with drug-resistant epilepsy. The following databases were searched from inception until June 2023; PubMed, Scopus, Embase, WOS, EBSCO, Cochrane Central, and Ovid MEDLINE. Pooled mean difference was calculated for change in seizure frequency (SF), and number of Interictal epileptiform discharges (IEDs) at different follow-up intervals. We included nine parallel randomized sham-controlled trials with a total of 267 patients. Active tDCS patients had a significantly lower SF per month at 4 and 8 weeks (MD = -4.06, 95% CI [-6.01 to -2.12], p