Faculty of Medicine and Surgery, University of Malta, Imsida, MSD2080, Malta.
Faculty of Medicine and Surgery, University of Malta, Imsida, MSD2080, Malta.
Clin Neurol Neurosurg. 2022 Dec;223:107516. doi: 10.1016/j.clineuro.2022.107516. Epub 2022 Nov 6.
At the turn of the 21st century, closed-loop deep brain stimulation (CL-DBS) systems have emerged as promising neuromodulatory treatment strategies, that integrate real-time feedback based on the brain's condition to fine-tune the stimulation being applied. CL-DBS promises numerous advantages over open-loop deep brain stimulation (OL-DBS) systems. However, no up-to-date review articles are available which characterise the clinical outcomes of CL-DBS therapy.
A systematic literature search was conducted in seven major databases with various keywords relating to CL-DBS, for non-randomised cohort studies, finalised clinical trials, case reports, and nonrandomised control trials published between 2011 and 2021.
Seven studies satisfied our inclusion criteria. Six investigated the use of CL-DBS therapy for neurological disorders, while one investigated its use for psychiatric disorders. The average patient age was 61 years (range: 27 - 78), and the mean disease duration before CL-DBS therapy was 15 years (range: 4 - 47). Patients included with essential tremor (ET) (n = 11) were older than patients with freezing of gait (FoG) in Parkinson's disease (PD) (n = 6) (p = 0.009), albeit insignificantly longer disease duration (p = 0.199). Following CL-DBS intervention, patients with ET (n = 11), major depressive disorder (n = 1) and Tourette syndrome (n = 1) had improvements in clinical outcomes, while PD patients had heterogeneous outcomes (n = 7). CL-DBS systems utilised by the included studies demonstrated a mean of 51.94 % (range: 36.62 - 68) energy-saving capacity over OL-DBS systems.
To date, there is insufficient evidence that CL-DBS offers significant superior clinical outcomes over OL-DBS. Our scoping review suggests that CL-DBS can improve symptoms of specific neurological and psychiatric disorders, whilst demonstrating improved energy-saving capacity which has the potential to decrease battery replacement surgeries. Real-time adjustment of patients' symptoms using CL-DBS may improve patients' overall quality of life. Further studies are required to validate our observations.
在 21 世纪之交，闭环深部脑刺激 (CL-DBS) 系统已成为有前途的神经调节治疗策略，它整合了基于大脑状况的实时反馈，以微调正在施加的刺激。CL-DBS 相对于开环深部脑刺激 (OL-DBS) 系统具有许多优势。然而，目前尚无描述 CL-DBS 治疗临床结果的最新综述文章。
在七个主要数据库中进行了系统文献检索，使用了与 CL-DBS 相关的各种关键词，以寻找非随机队列研究、最终临床试验、病例报告和 2011 年至 2021 年期间发表的非随机对照试验。
有七项研究符合我们的纳入标准。其中六项研究了 CL-DBS 治疗在神经疾病中的应用，一项研究了其在精神疾病中的应用。患者平均年龄为 61 岁（范围：27-78 岁），CL-DBS 治疗前的平均病程为 15 年（范围：4-47 年）。患有原发性震颤（ET）（n=11）的患者比患有帕金森病（PD）冻结步态（FoG）的患者年龄更大（n=6）（p=0.009），但病程明显更长（p=0.199）。在 CL-DBS 干预后，ET 患者（n=11）、重度抑郁症患者（n=1）和妥瑞氏综合征患者（n=1）的临床结局有所改善，而 PD 患者的结局则各不相同（n=7）。纳入研究中使用的 CL-DBS 系统相对于 OL-DBS 系统平均具有 51.94%（范围：36.62-68）的节能能力。
迄今为止，尚无证据表明 CL-DBS 比 OL-DBS 提供显著更好的临床结果。我们的范围综述表明，CL-DBS 可以改善特定神经和精神疾病的症状，同时具有提高节能能力的潜力，这有可能减少电池更换手术。使用 CL-DBS 实时调整患者的症状可能会提高患者的整体生活质量。需要进一步的研究来验证我们的观察结果。
