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Medicine Apr 2024Subthalamic nucleus deep brain stimulation (STN-DBS) is a viable therapeutic for advanced Parkinson's disease. However, the efficacy and safety of STN-DBS under local... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Subthalamic nucleus deep brain stimulation (STN-DBS) is a viable therapeutic for advanced Parkinson's disease. However, the efficacy and safety of STN-DBS under local anesthesia (LA) versus general anesthesia (GA) remain controversial. This meta-analysis aims to compare them using an expanded sample size.
METHODS
The databases of Embase, Cochrane Library and Medline were systematically searched for eligible cohort studies published between 1967 and 2023. Clinical efficacy was assessed using either Unified Parkinson's Disease Rating Scale (UPDRS) section III scores or levodopa equivalent dosage requirements. Subgroup analyses were performed to assess complications (adverse effects related to stimulation, general neurological and surgical complications, and hardware-related complications).
RESULTS
Fifteen studies, comprising of 13 retrospective cohort studies and 2 prospective cohort studies, involving a total of 943 patients were included in this meta-analysis. The results indicate that there were no significant differences between the 2 groups with regards to improvement in UPDRS III score or postoperative levodopa equivalent dosage requirement. However, subgroup analysis revealed that patients who underwent GA with intraoperative imaging had higher UPDRS III score improvement compared to those who received LA with microelectrode recording (MER) (P = .03). No significant difference was found in the improvement of UPDRS III scores between the GA group and LA group with MER. Additionally, there were no notable differences in the incidence rates of complications between these 2 groups.
CONCLUSIONS
Our meta-analysis indicates that STN-DBS performed under GA or LA have similar clinical outcomes and complications. Therefore, GA may be a suitable option for patients with severe symptoms who cannot tolerate the procedure under LA. Additionally, the GA group with intraoperative imaging showed better clinical outcomes than the LA group with MER. A more compelling conclusion would require larger prospective cohort studies with a substantial patient population and extended long follow-up to validate.
Topics: Humans; Deep Brain Stimulation; Parkinson Disease; Anesthesia, General; Subthalamic Nucleus; Anesthesia, Local; Treatment Outcome
PubMed: 38669414
DOI: 10.1097/MD.0000000000037955 -
Clinical Neurology and Neurosurgery Sep 2020Intracortical brain-machine interface (iBMI) is an assistive strategy to restore lost sensorimotor function by bridging the disrupted neural pathways to reanimate...
OBJECTIVE
Intracortical brain-machine interface (iBMI) is an assistive strategy to restore lost sensorimotor function by bridging the disrupted neural pathways to reanimate paralyzed limbs. However, to date, none of the studies explored the trade-offs between the performance criteria of different iBMI systems that decode discrete upper limb movements from intracortical neural recordings.
METHODS
A systematic review of electronic databases using different MeSH terms from January 1990 to December 2019 was conducted. IBM® SPSS statistics version 25 (Released 2017, Armonk, NY: IBM) was used to evaluate for differences between groups using independent sample t-tests.
RESULTS
A total of 18 patients from 15 studies were included in our analysis. The included studies involved iBMI controlled 5-robotic and 10-neuromuscular stimulated orthotics to perform skillful and coordinated movements that resulted in a clinically significant gain in tests of upper-limb functions. Pooled analysis revealed that the mean response time to execute 3-D reach and grasp task by the robotic-assisted limb was relatively longer (46.8 +/-101.5 s) compared to the neuro-muscular stimulated orthotics (15.8 +/-15.2 s); however, statistically insignificant [Mean difference (MD): 30.9, 95 % Confidence Interval (CI): -40.4-102.3, p = 0.35]. Furthermore, the accuracy in performing 3-D reach and grasp tasks after repetitive trials were better among patients with neuro-muscular stimulated orthotics (83.5 +/-12.7 %) compared to those with robotic-assisted prosthetic limb (69.1 +/- 23.6 %) with statistically significant difference (MD: 15.9, 95 % CI: 1.65-32.5, p = 0.05).
CONCLUSION
Our study demonstrates that iBMI-assisted prosthetic limbs showed better accuracy and shorter response time among patients with neuro-muscular stimulated orthotics compared to robotic neuro-prosthetics.
Topics: Artificial Limbs; Brain-Computer Interfaces; Electric Stimulation Therapy; Humans; Robotics; Spinal Cord Injuries; Upper Extremity
PubMed: 32682223
DOI: 10.1016/j.clineuro.2020.106069