Paro Mitch R, Dyrda Michal, Ramanan Srinath, Wadman Grant, Burke Stacey-Ann, Cipollone Isabella, Bosworth Cory, Zurek Sarah, Senatus Patrick B
1University of Connecticut School of Medicine, Farmington.
2University of Connecticut, Storrs.
J Neurosurg. 2022 Oct 28;138(6):1688-1701. doi: 10.3171/2022.8.JNS221334. Print 2023 Jun 1.
Stroke remains the leading cause of disability in the United States. Even as acute care for strokes advances, there are limited options for improving function once the patient reaches the subacute and chronic stages. Identification of new therapeutic approaches is critical. Deep brain stimulation (DBS) holds promise for these patients. A number of case reports and small case series have reported improvement in movement disorders after strokes in patients treated with DBS. In this systematic review, the authors have summarized the patient characteristics, anatomical targets, stimulation parameters, and outcomes of patients who have undergone DBS treatment for poststroke movement disorders.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Scopus, and SpringerLink databases were searched for the keywords "DBS," "stroke," "movement," and "recovery" to identify patients treated with DBS for movement disorders after a stroke. The Joanna Briggs Institute Critical Appraisal checklists for case reports and case series were used to systematically analyze the quality of the included studies. Data collected from each study included patient demographic characteristics, stroke diagnosis, movement disorder, DBS target, stimulation parameters, complications, and outcomes.
The authors included 29 studies that described 53 patients who underwent placement of 82 total electrodes. Movement disorders included tremor (n = 18), dystonia (n = 18), hemiballism (n = 6), spastic hemiparesis (n = 1), chorea (n = 1), and mixed disorders (n = 9). The most common DBS targets were the globus pallidus internus (n = 32), ventral intermediate nucleus of thalamus (n = 25), and subthalamic area/subthalamic nucleus (n = 7). Monopolar stimulation was reported in 43 leads and bipolar stimulation in 13. High-frequency stimulation was used in 57 leads and low-frequency stimulation in 6. All patients but 1 had improvement in their movement disorders. Two complications were reported: speech impairment in 1 patient and hardware infection in another. The median (interquartile range) duration between stroke and DBS treatment was 6.5 (2.1-15.8) years.
This is the first systematic review of DBS for poststroke movement disorders. Overall, most studies to date have been case reports and small series reporting heterogeneous patients and surgical strategies. This review suggests that DBS for movement disorders after a stroke has the potential to be effective and safe for diverse patients, and DBS may be a feasible option to improve function even years after a stroke.
在美国，中风仍是导致残疾的主要原因。尽管中风的急性护理有所进展，但一旦患者进入亚急性和慢性阶段，改善功能的选择仍然有限。确定新的治疗方法至关重要。深部脑刺激（DBS）为这些患者带来了希望。一些病例报告和小型病例系列报道了接受DBS治疗的中风患者运动障碍有所改善。在本系统评价中，作者总结了接受DBS治疗中风后运动障碍患者的特征、解剖靶点、刺激参数和治疗结果。
遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。在PubMed、Scopus和SpringerLink数据库中搜索关键词“DBS”“中风”“运动”和“恢复”，以确定接受DBS治疗中风后运动障碍的患者。使用乔安娜·布里格斯循证卫生保健中心病例报告和病例系列的批判性评价清单，系统分析纳入研究的质量。从每项研究中收集的数据包括患者人口统计学特征、中风诊断、运动障碍、DBS靶点、刺激参数、并发症和治疗结果。
作者纳入了29项研究，这些研究描述了53例患者，共植入了82个电极。运动障碍包括震颤（n = 18）、肌张力障碍（n = 18）、偏身投掷症（n = 6）、痉挛性偏瘫（n = 1）、舞蹈症（n = 1）和混合性障碍（n = 9）。最常见的DBS靶点是内侧苍白球（n = 32）、丘脑腹中间核（n = 25）和丘脑底区/丘脑底核（n = 7）。43根电极采用单极刺激，13根采用双极刺激。57根电极采用高频刺激，6根采用低频刺激。除1例患者外，所有患者的运动障碍均有改善。报告了2例并发症：1例患者出现言语障碍，另1例出现硬件感染。中风与DBS治疗之间的中位（四分位间距）持续时间为6.5（2.1 - 15.8）年。
这是首次对DBS治疗中风后运动障碍进行的系统评价。总体而言，迄今为止大多数研究都是病例报告和小型系列报道，患者和手术策略各不相同。本评价表明，DBS治疗中风后运动障碍对不同患者可能有效且安全，即使在中风多年后，DBS也可能是改善功能的可行选择。
