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Given the cognitive\/neurobehavioral impact of epilepsy and the putative neuroplasticity with neuromodulation, we aimed to understand the effect of RNS on cognition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched four databases, PubMed\/Medline, EMBASE, Web of Science, and Cochrane, from inception until April 2025. Primary outcomes were neuropsychological tests in global intellectual functioning and across five cognitive domains: language, memory, executive functioning, visuospatial functioning, and attention\/processing speed. We also included measures evaluating depression and anxiety symptoms and quality of life in epilepsy. A random\u2010effects meta\u2010analysis was performed when at least two measures were available across studies, calculating the standardized mean difference (SMD) and 95% confidence interval (CI) between baseline and postoperative testing at or over 12\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2227 articles identified, we included 10 studies in our qualitative systematic review and five nonduplicated studies (373 patients) in our meta\u2010analysis. Intellectual functioning, cognitive functioning, depression, anxiety, and quality of life either improved or remained stable across the included studies. Meta\u2010analysis revealed nonsignificant changes in intellectual functioning (SMD = \u2212.03, 95% CI = \u2212.49 to .42) and two of the five cognitive domains: language (Boston Naming Test: SMD = .12, 95% CI = \u2212.10 to .33; Verbal Comprehension Index: SMD = \u2212.16, 95% CI = \u2212.58 to .26) and visuospatial functioning (Perceptual Reasoning Index: SMD = .07, 95% CI = \u2212.36 to .49). The remaining domains could not be evaluated given the limited number of studies. For mood, meta\u2010analysis revealed a nonsignificant decrease in depression score (Beck Depression Inventory\u2010II: SMD = \u2212.14, 95% CI = \u2212.33 to .06). GRADE (Grading of Recommendations Assessment, Development, and Evaluation) certainty of evidence was moderate for intellectual and visuospatial functioning and high for language and depression measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Our systematic review and meta\u2010analysis suggest that RNS does not impact neuropsychological and neurobehavioral outcomes at a group level, at least for the measures examined. We review putative mechanisms by which RNS may impact cognition and offer suggestions for future research in this domain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.18505","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T03:10:52Z","timestamp":1750216252000},"page":"3585-3601","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Neuropsychological and neurobehavioral outcomes of responsive neurostimulation in epilepsy: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6477-8423","authenticated-orcid":false,"given":"Marco","family":"Malaga","sequence":"first","affiliation":[{"name":"Department of Neurology Baylor College of Medicine  Houston 77030 Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6064-7082","authenticated-orcid":false,"given":"Yosefa","family":"Modiano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery McGovern Medical School at University of Texas Health Science Center  Houston 77030 Texas USA"},{"name":"Texas Institute for Restorative Neurotechnologies University of Texas Health Science Center  Houston 77030 Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0720-1417","authenticated-orcid":false,"given":"Zulfi","family":"Haneef","sequence":"additional","affiliation":[{"name":"Department of Neurology Baylor College of Medicine  Houston 77030 Texas USA"},{"name":"Neurology Care Line Michael E. 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