Neurosurgery

Epilepsy surgery modestly improves mood and QoL; seizure freedom drives benefit

Systematic review/meta-analysis of 42 studies (n=6218) found pooled depression improvement was small-to-moderate (SMD = -0.24). When patients achieved seizure freedom the effect on depression was larger (SMD = -0.47); no meaningful change with persistent seizures. Epilepsy-related psychoses fell from 17.5% preop to 4.2% postop, but 16.3% developed de novo psychiatric disorders (most commonly depression and anxiety). Verbal memory decline occurred in 17–37% after temporal lobe surgery, though seizure freedom mitigated quality-of-life impact. 1

Pivotal device trials rarely integrate equity-focused design or analyses

Scoping review of 74 pivotal device trials (predominantly RCTs) found age and sex were reported but rarely analyzed in subgroup frameworks. Race/ethnicity was reported in 35.1% of studies and seldom included in outcome analyses, limiting external validity. Only 2.7% of trials explicitly framed equity in design or recruitment, and no trial used CONSORT‑Equity reporting guidance. 2

Noninvasive neuromodulation for headache shows promise but trial quality varies

Systematic review of 70 trials (1990–2024) covering nVNS, e‑TNS, sTMS/rTMS, and REN found heterogeneous endpoints and variable IHS guideline adherence. Acute migraine trials were often randomized and sham‑controlled; preventive trials showed greater methodological variability. For cluster headache, evidence exists only for nVNS, and the authors conclude larger, robust sham‑controlled trials are needed to confirm efficacy. 3