Drug-resistant epilepsy is a challenging condition that affects around 30% of all patients with epilepsy. Evidence regarding treatment options is limited, especially for surgery and invasive techniques. However, non-invasive techniques constitute a promising alternative for these patients. This meta-analysis aims to evaluate the effectiveness of transcranial direct current stimulation on seizure frequency management in patients with drug-resistant epilepsy. We searched the literature in PubMed, Scopus, and Web of Science up to December 2023. We included randomized controlled trials that compared transcranial direct current stimulation with sham stimulation. Our main outcomes of interest were a percentage reduction in seizure frequency and epileptiform discharge frequency. A total of 10 studies with 269 patients were included. Monthly seizure frequency was significantly reduced by an average of -45.39%and -39.34% at week 4 and week 8, respectively. There was a significant reduction in IED in favor of tDCS at week 2 (SMD = -0.87, 95% CI = [− 1.49, − 0.25], P = 0.006), 4 weeks (SMD = -1.17, 95% CI = [− 1.67, − 0.66], P < 0.00001, Moderate quality of evidence) and 8 weeks (SMD = -1.11, 95% CI = [− 1.69, − 0.53], P = 0.0002) of follow-up. There were no serious adverse events associated with the stimulation. Transcranial direct current stimulation was associated with a reduction in both seizure frequency and epileptiform discharges with minimal side effects. Further studies with larger sample sizes and consensus protocol guidelines are needed to verify its long-term safety and effectiveness.

The coexistence of atrial fibrillation (AF) with heart failure (HF) is prevalent, leading to severe complications. This review aimed to investigate the success rate and efficacy of cryoballoon ablation (CBA) by measuring the improvement in the New York Heart Association (NYHA) classification and the effect on the left ventricular systolic function in patients with AF accompanied by heart failure with reduced ejection fraction (HFrEF). Electronic databases search included PubMed, Web of Science, and Scopus in January 2023. Outcomes addressed the following: left ventricular ejection fraction (LVEF) improvement, AF recurrence, NYHA classification improvement, and mortality. STATA 17.0 software was used for data analysis. The effect size for the studies was a standard mean difference (SMD) with a 95% confidence interval (CI) for outcomes. Proportion analysis with 95% CI was used for freedom from early AF and AF after 2 years and all‐cause death. We included six studies, including 1699 HF patients with 365 HFrEF patients. The SMD of postoperative LVEF compared to preoperative LVEF in HFrEF was 0.99 ([95% CI: 0.60, 1.39], p = .00), and for NYHA was −1.12 ([95% CI: −1.36, −0.87], p = .00). The analysis results in HFrEF patients for freedom from AF after 1 year was 65% ([95% CI: 0.55, 0.75], and after 2 years was 39% ([95% CI: 0.10, 0.67]). Proportional analysis was conducted for all‐cause death, resulting in 3% mortality ([95% CI: −0.01, 0.07]). Cryoablation of AF accompanied by HFrEF appeared safe as it reduced AF recurrence and enhanced clinical outcomes.

Autism spectrum disorder (ASD) is a complex range of neurodevelopmental disorders. The treatment of ASD is challenging since there are no approved drugs except for risperidone and aripiprazole, which have a limited effect on core symptoms and are associated with a wide range of adverse events. Bumetanide is a loop diuretic suggested to play a role in ASD symptoms by modulating the GABAergic system. This meta-analysis aims to evaluate the efficacy and safety of bumetanide on ASD symptom management. We included randomized controlled trials comparing bumetanide with placebo or conventional treatment. Our primary outcomes included the Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS-2), Clinical Global Impression- Efficacy Index (CGI-EI), Social interaction (SI), repetitive behavior and restricted interests (RRB), and adverse events. Bumetanide was associated with significant improvement in CARS total score (MD = -2.28; 95% CI = [-4.07, -0.49], p = 0.01) and CGI-EI (MD = 0.27; 95% CI = [0.09, 0.44], p = 0.003) compared to placebo. However, no significant difference was found in the SRS-2 score. Findings for SI and RRB were inconsistent depending on the pooled scales, with significant results observed when pooling SRS-2 but not when pooling ADOS. Bumetanide was generally safe and well-tolerated. Common adverse events include polyurea, hypokalemia, and dehydration. Although statistically significant improvements were observed on some measures, we cannot conclude the superiority of bumetanide in alleviating ASD symptoms. Further large clinical trials should be conducted to determine the effect of bumetanide on different symptoms of ASD and the variation in treatment effect among different patient populations.

Background: Gamma desynchronization is an early pathophysiological event in Alzheimer’s disease with a disturbance in oscillation in the gamma frequency range 30‐80 Hz. This disruption was found to be directly related to the disease progression and severity. Thus, the use of transcranial alternating current stimulation (tACS) possessed greater interest. tACS can induce synchronization of neural networks leading to improvement in behavior and cognition. However, there’s still controversy regarding the beneficial effect of tACS in improving cognition and memory in Alzheimer’s disease patients. This systematic review and meta‐analysis aims to pool and synthesize evidence from randomized controlled trials to assess the efficacy of tACS on memory and cognition in patients with mild cognitive impairment or Alzheimer’s disease.Method: We searched PubMed, Scopus, Web of Science up to Dec 17, 2023. We included a total of seven randomized controlled trials comprising 246 patients with Alzheimer’s disease or mild cognitive impairment. Our primary outcomes were Rey auditory verbal learning scale (RAVL), short latency afferent inhibition (SAI), and face‐name association task (FNAT).Result: There was a significant difference between tACS and sham groups in favor of tACS in RAVL immediate recall (MD = 8.80, 95% CI = [5.22, 12.38], P < 0.00001), delayed recall (MD = 1.34, 95% CI = [0.78, 1.89], P < 0.00001), and total recall (MD = 10.62, 95% CI = [5.33, 15.92], P < 0.00001). Short latency afferent inhibition was significantly reduced in the tACS group compared to sham group (MD = ‐0.35, 95% CI = [‐0.41, ‐0.29], P < 0.00001). There was also a significant difference in FNAT in favor of tACS group (MD = 3.29, 95% CI = [2.50, 4.08], P < 0.00001)Conclusion: Preliminary evidence suggests the potential efficacy of tACS for improving cognition in Alzheimer’s disease patients. However, due to the limited number of studies and the small sample size, there’s still insufficient evidence to conclude a decision regarding this matter. More standardized, large clinical trials are needed to establish better evidence.