-
Stereotactic and Functional Neurosurgery 2023Chronic cluster headache (CCH) is a severe and debilitating sub-type of trigeminal autonomic cephalalgia that can be resistant to medical management and associated with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic cluster headache (CCH) is a severe and debilitating sub-type of trigeminal autonomic cephalalgia that can be resistant to medical management and associated with significant impairment in quality of life. Studies of deep brain stimulation (DBS) for CCH have provided promising results but have not been assessed in a comprehensive systematic review/meta-analysis.
OBJECTIVE
The objective was to perform a systematic literature review and meta-analysis of patients with CCH treated with DBS to provide insight on safety and efficacy.
METHODS
A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. 16 studies were included in final analysis. A random-effects model was used to meta-analyze data.
RESULTS
Sixteen studies reported 108 cases for data extraction and analysis. DBS was feasible in >99% of cases and was performed either awake or asleep. Meta-analysis revealed that the mean difference in headache attack frequency and headache intensity after DBS were statistically significant (p < 0.0001). Utilization of microelectrode recording was associated with statistically significant improvement in headache intensity postoperatively (p = 0.006). The average overall follow-up period was 45.4 months and ranged from 1 to 144 months. Death occurred in <1%. The rate of major complications was 16.67%.
CONCLUSIONS
DBS for CCHs is a feasible surgical technique with a reasonable safety profile that can be successfully performed either awake or asleep. In carefully selected patients, approximately 70% of patients achieve excellent control of their headaches.
Topics: Humans; Cluster Headache; Deep Brain Stimulation; Quality of Life; Wakefulness; Headache; Treatment Outcome
PubMed: 37245509
DOI: 10.1159/000530508 -
Journal of Parkinson's Disease 2022STN-DBS is a cornerstone in the treatment of advanced Parkinson's disease (PD). The traditional approach is to use an awake operative technique with microelectrode... (Meta-Analysis)
Meta-Analysis
BACKGROUND
STN-DBS is a cornerstone in the treatment of advanced Parkinson's disease (PD). The traditional approach is to use an awake operative technique with microelectrode recording (MER). However, more centers start using an asleep MRI-guided technique without MER.
OBJECTIVE
We systematically reviewed the literature to compare STN-DBS surgery with and without MER for differences in clinical outcome.
METHODS
We systematically searched PubMed, Embase, MEDLINE, and Web of Science databases for randomized clinical trials and consecutive cohort studies published between 01-01-2000 and 26-08-2021, that included at least 10 PD patients who had received bilateral STN-DBS.
RESULTS
2,129 articles were identified. After abstract screening and full-text review, 26 studies were included in the final analysis, comprising a total of 34 study groups (29 MER and 5 non-MER). The standardized mean difference (SMD) in change in motor symptoms between baseline (OFF medication) and 6-24 months follow-up (OFF medication and ON stimulation) was 1.64 for the MER group and 1.87 for non-MER group (p = 0.59). SMD in change in levodopa equivalent daily dose (LEDD) was 1.14 for the MER group and 0.65 for non-MER group (p < 0.01). Insufficient data were available for comparative analysis of PDQ-39 and complications.
CONCLUSION
The change in motor symptoms from baseline to follow-up did not differ between studies that used MER and those that did not. The postoperative reduction in LEDD from baseline to follow-up was greater in the MER-group. In the absence of high-quality studies comparing both methods, there is a clear need for a well-designed comparative trial.
Topics: Deep Brain Stimulation; Humans; Levodopa; Microelectrodes; Parkinson Disease; Subthalamic Nucleus; Treatment Outcome
PubMed: 35912752
DOI: 10.3233/JPD-223333 -
World Neurosurgery Mar 2023Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage.
OBJECTIVES
To provide a comprehensive systematic review and meta-analysis reporting complication rates from deep brain stimulation in PD. We also interrogate the association between hemorrhage and MER.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were implemented while querying the Pubmed, Embase, and Cochrane databases. All included studies were randomized controlled trials and prospective case series with 5 or more patients. Primary outcomes included rates of overall revision, infection, lead malposition, surgical site and wound complications, hardware-related complications, and seizure. The secondary outcome was the relationship between number of MER tracks and hemorrhage rate.
RESULTS
262 articles with 21,261 patients were included in the analysis. Mean follow-up was 25.8 months (range 0-133). Complication rates were: revision 4.9%, infection 4.2%, lead malposition 3.3%, surgical site complications 2.8%, hemorrhage 2.4%, hardware-related complications 2.4%, and seizure 1.9%. While hemorrhage rate did not increase with single-track MER (odds ratio, 3.49; P = 0.29), there was a significant non-linear increase with each additional track.
CONCLUSION
Infection and lead malposition were the most common complications. Hemorrhage risk increases with more than one MER track. These results highlight the challenge of balancing surgical accuracy and perioperative risk.
Topics: Humans; Parkinson Disease; Deep Brain Stimulation; Neurosurgical Procedures; Microelectrodes; Seizures; Randomized Controlled Trials as Topic
PubMed: 36244666
DOI: 10.1016/j.wneu.2022.10.034 -
Reviews in the Neurosciences Feb 2024In this systematic review, we address the status of intracortical brain-computer interfaces (iBCIs) applied to the motor cortex to improve function in patients with... (Review)
Review
In this systematic review, we address the status of intracortical brain-computer interfaces (iBCIs) applied to the motor cortex to improve function in patients with impaired motor ability. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines for Systematic Reviews. Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) and the Effective Public Health Practice Project (EPHPP) were used to assess bias and quality. Advances in iBCIs in the last two decades demonstrated the use of iBCI to activate limbs for functional tasks, achieve neural typing for communication, and other applications. However, the inconsistency of performance metrics employed by these studies suggests the need for standardization. Each study was a pilot clinical trial consisting of 1-4, majority male (64.28 %) participants, with most trials featuring participants treated for more than 12 months (55.55 %). The systems treated patients with various conditions: amyotrophic lateral sclerosis, stroke, spinocerebellar degeneration without cerebellar involvement, and spinal cord injury. All participants presented with tetraplegia at implantation and were implanted with microelectrode arrays via pneumatic insertion, with nearly all electrode locations solely at the precentral gyrus of the motor cortex (88.88 %). The development of iBCI devices using neural signals from the motor cortex to improve motor-impaired patients has enhanced the ability of these systems to return ability to their users. However, many milestones remain before these devices can prove their feasibility for recovery. This review summarizes the achievements and shortfalls of these systems and their respective trials.
Topics: Humans; Male; Brain-Computer Interfaces; Electrodes, Implanted; Quadriplegia; Spinal Cord Injuries; Stroke
PubMed: 37845811
DOI: 10.1515/revneuro-2023-0077 -
Neuromodulation : Journal of the... Jun 2024Systematic review of the literature. (Review)
Review
STUDY DESIGN
Systematic review of the literature.
OBJECTIVES
In recent years, brain-computer interface (BCI) has emerged as a potential treatment for patients with spinal cord injury (SCI). This is the first systematic review of the literature on invasive closed-loop BCI technologies for the treatment of SCI in humans.
MATERIALS AND METHODS
A comprehensive search of PubMed MEDLINE, Web of Science, and Ovid EMBASE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Of 8316 articles collected, 19 studies met all the inclusion criteria. Data from 21 patients were extracted from these studies. All patients sustained a cervical SCI and were treated using either a BCI with intracortical microelectrode arrays (n = 18, 85.7%) or electrocorticography (n = 3, 14.3%). To decode these neural signals, machine learning and statistical models were used: support vector machine in eight patients (38.1%), linear estimator in seven patients (33.3%), Hidden Markov Model in three patients (14.3%), and other in three patients (14.3%). As the outputs, ten patients (47.6%) underwent noninvasive functional electrical stimulation (FES) with a cuff; one (4.8%) had an invasive FES with percutaneous stimulation, and ten (47.6%) used an external device (neuroprosthesis or virtual avatar). Motor function was restored in all patients for each assigned task. Clinical outcome measures were heterogeneous across all studies.
CONCLUSIONS
Invasive techniques of BCI show promise for the treatment of SCI, but there is currently no technology that can restore complete functional autonomy in patients with SCI. The current techniques and outcomes of BCI vary greatly. Because invasive BCIs are still in the early stages of development, further clinical studies should be conducted to optimize the prognosis for patients with SCI.
Topics: Spinal Cord Injuries; Humans; Brain-Computer Interfaces; Recovery of Function
PubMed: 37943244
DOI: 10.1016/j.neurom.2023.10.006 -
Stereotactic and Functional Neurosurgery 2023Deep brain stimulation (DBS) is a neurosurgical treatment used for the treatment of movement disorders. Surgical and perioperative complications, although infrequent,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Deep brain stimulation (DBS) is a neurosurgical treatment used for the treatment of movement disorders. Surgical and perioperative complications, although infrequent, can result in clinically significant neurological impairment.
OBJECTIVES
In this study, we evaluated the incidence and risk factors of intracranial bleeding in DBS surgery.
METHOD
Medline, EMBASE, and Cochrane were screened in line with PRISMA 2020 guidelines to capture studies reporting on the incidence of hemorrhagic events in DBS. After removing duplicates, the search yielded 1,510 papers. Abstracts were evaluated by two independent reviewers for relevance. A total of 386 abstracts progressed to the full-text screen and were assessed against eligibility criteria. A total of 151 studies met the criteria and were included in the analysis. Any disagreement between the reviewers was resolved by consensus. Relevant data points were extracted and analyzed in OpenMeta [Analyst] software.
RESULTS
The incidence of intracranial bleeding was 2.5% (95% CI: 2.2-2.8%) per each patient and 1.4% (95% CI: 1.2-1.6%) per each implanted lead. There was no statistically significant difference across implantation targets and clinical indications. Patients who developed an intracranial bleed were on average 5 years older (95% CI: 1.26-13.19), but no difference was observed between the genders (p = 0.891). A nonsignificant trend was observed for a higher risk of bleeding in patients with hypertension (OR: 2.99, 95% CI: 0.97-9.19) (p = 0.056). The use of microelectrode recording did not affect the rate of bleeding (p = 0.79).
CONCLUSIONS
In this review, we find that the rate of bleeding per each implanted lead was 1.4% and that older patients had a higher risk of hemorrhage.
Topics: Humans; Male; Female; Deep Brain Stimulation; Intracranial Hemorrhages; Movement Disorders; Risk Factors
PubMed: 37232022
DOI: 10.1159/000530398 -
Journal of Neurosurgery Mar 2024Deep brain stimulation (DBS) is an effective treatment for medically refractory movement disorders and other neurological conditions. To comprehensively characterize the...
OBJECTIVE
Deep brain stimulation (DBS) is an effective treatment for medically refractory movement disorders and other neurological conditions. To comprehensively characterize the prevalence, locations, timing of detection, clinical effects, and risk factors of DBS-related intracranial hemorrhage (ICH), the authors performed a systematic review of the published literature.
METHODS
PubMed, EMBASE, and Web of Science were searched using 2 concepts: cerebral hemorrhage and brain stimulation, with filters for English, human studies, and publication dates 1980-2023. The inclusion criteria were the use of DBS intervention for any human neurological condition, with documentation of hemorrhagic complications by location and clinical effect. Studies with non-DBS interventions, no documentation of hemorrhage outcome, patient cohorts of ≤ 10, and pediatric patients were excluded. The risk of bias was assessed using Centre for Evidence-Based Medicine Levels of Evidence. The authors performed proportional meta-analysis for ICH prevalence.
RESULTS
A total of 63 studies, with 13,056 patients, met the inclusion criteria. The prevalence of ICH was 2.9% (fixed-effects model, 95% CI 2.62%-3.2%) per patient and 1.6% (random-effects model, 95% CI 1.34%-1.87%) per DBS lead, with 49.6% being symptomatic. The ICH rates did not change with time. ICH most commonly occurred around the DBS lead, with 16% at the entry point, 31% along the track, and 7% at the target. Microelectrode recording (MER) during DBS was associated with increased ICH rate compared to DBS without MER (3.5 ± 2.2 vs 2.1 ± 1.4; p[T ≤ t] 1-tail = 0.038). Other reported ICH risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal DBS trajectories, and multiple microelectrode insertions. Sixty percent of ICH was detected at 24 hours postoperatively and 27% intraoperatively. The all-cause mortality rate of DBS was 0.4%, with ICH accounting for 22% of deaths. Single-surgeon DBS experience showed a weak inverse correlation (r = -0.27, p = 0.2189) between the rate of ICH per lead and the number of leads implanted per year.
CONCLUSIONS
This study provides level III evidence that MER during DBS is a risk factor for ICH. Other risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal trajectories, and multiple microelectrode insertions. Avoidance of these risk factors may decrease the rate of ICH.
PubMed: 38518284
DOI: 10.3171/2024.1.JNS232385 -
Stereotactic and Functional Neurosurgery 2024Deep brain stimulation (DBS) is a well-established surgical therapy for patients with Parkinsons' Disease (PD). Traditionally, DBS surgery for PD is performed under... (Meta-Analysis)
Meta-Analysis Comparative Study
INTRODUCTION
Deep brain stimulation (DBS) is a well-established surgical therapy for patients with Parkinsons' Disease (PD). Traditionally, DBS surgery for PD is performed under local anesthesia, whereby the patient is awake to facilitate intraoperative neurophysiological confirmation of the intended target using microelectrode recordings. General anesthesia allows for improved patient comfort without sacrificing anatomic precision and clinical outcomes.
METHODS
We performed a systemic review and meta-analysis on patients undergoing DBS for PD. Published randomized controlled trials, prospective and retrospective studies, and case series which compared asleep and awake techniques for patients undergoing DBS for PD were included. A total of 19 studies and 1,900 patients were included in the analysis.
RESULTS
We analyzed the (i) clinical effectiveness - postoperative UPDRS III score, levodopa equivalent daily doses and DBS stimulation requirements. (ii) Surgical and anesthesia related complications, number of lead insertions and operative time (iii) patient's quality of life, mood and cognitive measures using PDQ-39, MDRS, and MMSE scores. There was no significant difference in results between the awake and asleep groups, other than for operative time, for which there was significant heterogeneity.
CONCLUSION
With the advent of newer technology, there is likely to have narrowing differences in outcomes between awake or asleep DBS. What would therefore be more important would be to consider the patient's comfort and clinical status as well as the operative team's familiarity with the procedure to ensure seamless transition and care.
Topics: Deep Brain Stimulation; Humans; Parkinson Disease; Wakefulness; Anesthesia, General; Treatment Outcome; Anesthesia
PubMed: 38636468
DOI: 10.1159/000536310 -
World Neurosurgery Oct 2021Deep brain stimulation (DBS) is a frequently applied therapy in primary dystonia. For secondary dystonia, the effects can be less favorable. We share our long-term... (Comparative Study)
Comparative Study
Deep Brain Stimulation of the Globus Pallidus Internus for Secondary Dystonia: Clinical Cases and Systematic Review of the Literature Regarding the Effectiveness of Globus Pallidus Internus versus Subthalamic Nucleus.
OBJECTIVE
Deep brain stimulation (DBS) is a frequently applied therapy in primary dystonia. For secondary dystonia, the effects can be less favorable. We share our long-term findings in 9 patients with severe secondary dystonia and discuss these findings in the light of the literature.
METHODS
Patients who had undergone globus pallidus internus (GPi)-DBS for secondary dystonia were included. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores, clinical improvement rates, follow-up periods, stimulation parameters and the need for internal pulse generator replacements were analyzed. The PubMed and Google Scholar databases were searched for articles describing GPi-DBS and subthalamic nucleus (STN)-DBS only for secondary dystonia cases. Keywords were "dystonia," "deep brain stimulation," "GPi," "dystonia," "deep brain stimulation," and "STN."
RESULTS
A total of 9 secondary dystonia patients (5 male, 4 female) had undergone GPi-DBS with microelectrode recording in our units. The mean follow-up period was 29 months. The average BFMDRS score was 58.2 before the surgery, whereas the mean value was 36.5 at the last follow-up of the patients (mean improvement, 39%; minimum, 9%; maximum, 63%). In the literature review, we identified 264 GPi-DBS cases (mean follow-up, 19 months) in 72 different articles about secondary dystonia. The mean BFMDRS improvement rate was 52%. In 146 secondary dystonia cases, reported in 19 articles, STN-DBS was performed. The average follow-up period was 20 months and the improvement in BFMDRS score was 66%.
CONCLUSIONS
Although GPi-DBS has favorable long-term efficacy and safety in the treatment of patients with secondary dystonia, STN seems a promising target for stimulation in patients with secondary dystonia. Further studies including a large number of patients, longer follow-up periods, and more homogenous patients are necessary to establish the optimal target for DBS in the management of secondary dystonias.
Topics: Deep Brain Stimulation; Dystonia; Globus Pallidus; Humans; Subthalamic Nucleus; Treatment Outcome
PubMed: 34303854
DOI: 10.1016/j.wneu.2021.07.070 -
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