Kalogirou Evangelos, Voulgaris Spyridon, Alexiou George A
Department of Neurosurgery, University of Ioannina, School of Medicine, 45500, Ioannina, Greece.
Neurosurg Rev. 2025 Jun 17;48(1):512. doi: 10.1007/s10143-025-03661-4.
To analyze studies employing multiple-target deep brain stimulation (DBS) for non-parkinsonian movement disorders and identify potential indications, therapeutic outcomes, and associated side effects.
We systematically screened PubMed and included studies involving patients treated with DBS targeting at least two brain regions, synchronous stimulation of ≥2 regions, patient data regarding symptoms/disease, and reported outcomes. Exclusion criteria included animal studies and reports lacking original data.
Twenty-seven studies were identified, included and analyzed; general trends were noted for each disorder. For essential tremor multi-target DBS (VIM+VOA/VOP) demonstrated promising outcomes regarding symptom improvement and reduction of side-effects. For multiple Sclerosis Tremor limited evidence suggested positive outcomes, comparable to standard DBS. The VIM/VOP border has been highlighted as a promising target. Regarding holmes Tremor although limited to case reports, multi-target DBS yielded favorable outcomes with minimal adverse effects. Finaly for dystonia multi-target DBS (GPi+VIM, GPi+VO) effectively addressed tremor and dystonic features. Statistically significant advantages were demonstrated over single-target stimulation in myoclonus-dystonia and hemidystonia.
While variability in target selection, methodologies, and outcomes precludes a meta-analysis, evidence supports the potential role of multi-target DBS in cases where single-target stimulation is inadequate. Promising target combinations, such as GPi+VIM (myoclonus-dystonia) and VIM+VOA (essential tremor), warrant further clinical exploration. The heterogeneity and predominance of case reports highlight the need for high-quality, controlled studies to refine indications and optimize strategies for multi-target DBS.
分析采用多靶点深部脑刺激（DBS）治疗非帕金森氏运动障碍的研究，并确定潜在适应症、治疗效果及相关副作用。
我们系统检索了PubMed，并纳入了涉及接受DBS治疗的患者的研究，这些患者的靶点至少为两个脑区，同步刺激≥2个脑区，有关于症状/疾病的患者数据以及报告的结果。排除标准包括动物研究和缺乏原始数据的报告。
共识别、纳入并分析了27项研究；每种疾病都有总体趋势。对于特发性震颤，多靶点DBS（腹中间核+腹前外侧核/腹后外侧核）在症状改善和副作用减少方面显示出有前景的结果。对于多发性硬化震颤，有限的证据表明有积极结果，与标准DBS相当。腹中间核/腹后外侧核边界已被强调为一个有前景的靶点。关于霍尔姆斯震颤，虽然仅限于病例报告，但多靶点DBS产生了良好的结果且副作用最小。最后对于肌张力障碍，多靶点DBS（苍白球内侧部+腹中间核，苍白球内侧部+腹前核）有效解决了震颤和肌张力障碍特征。在肌阵挛性肌张力障碍和偏侧肌张力障碍中，与单靶点刺激相比显示出统计学上的显著优势。
虽然靶点选择、方法和结果的差异使得无法进行荟萃分析，但证据支持多靶点DBS在单靶点刺激不足的情况下的潜在作用。有前景的靶点组合，如苍白球内侧部+腹中间核（肌阵挛性肌张力障碍）和腹中间核+腹前外侧核（特发性震颤），值得进一步的临床探索。病例报告的异质性和主导性凸显了高质量对照研究对于完善多靶点DBS的适应症和优化策略的必要性。
