PDF(Pubmed)
Abstract：
BACKGROUND: The management of patients with disorders of consciousness (DOC) presents substantial challenges in clinical practice. Deep brain stimulation (DBS) has emerged as a potential therapeutic approach, but the lack of standardized regulatory parameters for DBS in DOC hinders definitive conclusions.
OBJECTIVE: This comprehensive review aims to provide a detailed summary of the current issues concerning patient selection, target setting, and modulation parameters in clinical studies investigating the application of DBS for DOC patients.
METHODS: A meticulous systematic analysis of the literatures was conducted, encompassing articles published from 1968 to April 2023, retrieved from reputable databases (PubMed, Embase, Medline, and Web of Science).
RESULTS: The systematic analysis of 21 eligible articles, involving 146 patients with DOC resulting from acquired brain injury or other disorders, revealed significant insights. The most frequently targeted regions were the Centromedian-parafascicular complex (CM-pf) nuclei and central thalamus (CT), both recognized for their role in regulating consciousness. However, other targets have also been explored in different studies. The stimulation frequency was predominantly set at 25 or 100 Hz, with pulse width of 120 μs, and voltages ranged from 0 to 4 V. These parameters were customized based on individual patient responses and evaluations. The overall clinical efficacy rate in all included studies was 39.7%, indicating a positive effect of DBS in a subset of DOC patients. Nonetheless, the assessment methods, follow-up durations, and outcome measures varied across studies, potentially contributing to the variability in reported efficacy rates.
CONCLUSIONS: Despite the challenges arising from the lack of standardized parameters, DBS shows promising potential as a therapeutic option for patients with DOC. However, there still remains the need for standardized protocols and assessment methods, which are crucial to deepen the understanding and optimizing the therapeutic potential of DBS in this specific patient population.
OBJECTIVE: This comprehensive review aims to provide a detailed summary of the current issues concerning patient selection, target setting, and modulation parameters in clinical studies investigating the application of DBS for DOC patients.
METHODS: A meticulous systematic analysis of the literatures was conducted, encompassing articles published from 1968 to April 2023, retrieved from reputable databases (PubMed, Embase, Medline, and Web of Science).
RESULTS: The systematic analysis of 21 eligible articles, involving 146 patients with DOC resulting from acquired brain injury or other disorders, revealed significant insights. The most frequently targeted regions were the Centromedian-parafascicular complex (CM-pf) nuclei and central thalamus (CT), both recognized for their role in regulating consciousness. However, other targets have also been explored in different studies. The stimulation frequency was predominantly set at 25 or 100 Hz, with pulse width of 120 μs, and voltages ranged from 0 to 4 V. These parameters were customized based on individual patient responses and evaluations. The overall clinical efficacy rate in all included studies was 39.7%, indicating a positive effect of DBS in a subset of DOC patients. Nonetheless, the assessment methods, follow-up durations, and outcome measures varied across studies, potentially contributing to the variability in reported efficacy rates.
CONCLUSIONS: Despite the challenges arising from the lack of standardized parameters, DBS shows promising potential as a therapeutic option for patients with DOC. However, there still remains the need for standardized protocols and assessment methods, which are crucial to deepen the understanding and optimizing the therapeutic potential of DBS in this specific patient population.
摘要：
背景：意识障碍（DOC）患者的管理在临床实践中提出了重大挑战。深部脑刺激（DBS）已成为一种潜在的治疗方法，但是DOC中DBS缺乏标准化的监管参数阻碍了明确的结论。
目的：本综述旨在详细总结当前有关患者选择的问题，目标设定,和调制参数在研究DBS在DOC患者中的应用的临床研究中。
方法：对文献进行了细致的系统分析，涵盖1968年至2023年4月发表的文章，从信誉良好的数据库中检索(PubMed，Embase,Medline,和WebofScience)。
结果：对21篇合格文章的系统分析，涉及146例因获得性脑损伤或其他疾病导致的DOC患者，揭示了重要的见解。最常见的目标区域是中央正中-旁肌复合体（CM-pf）核和中央丘脑（CT），两者都承认他们在调节意识方面的作用。然而,在不同的研究中也探索了其他目标。刺激频率主要设置在25或100Hz，脉冲宽度为120μs，电压范围为0至4V。这些参数是根据个体患者的反应和评估定制的。所有纳入研究的临床总有效率为39.7%,表明DBS在部分DOC患者中具有积极作用。尽管如此，评估方法，随访持续时间，结果测量因研究而异，可能导致报告的有效率差异。
结论：尽管缺乏标准化参数带来了挑战，DBS作为DOC患者的治疗选择显示出很有希望的潜力。然而,仍然需要标准化的协议和评估方法，这对于加深理解和优化DBS在这一特定患者人群中的治疗潜力至关重要。
目的：本综述旨在详细总结当前有关患者选择的问题，目标设定,和调制参数在研究DBS在DOC患者中的应用的临床研究中。
方法：对文献进行了细致的系统分析，涵盖1968年至2023年4月发表的文章，从信誉良好的数据库中检索(PubMed，Embase,Medline,和WebofScience)。
结果：对21篇合格文章的系统分析，涉及146例因获得性脑损伤或其他疾病导致的DOC患者，揭示了重要的见解。最常见的目标区域是中央正中-旁肌复合体（CM-pf）核和中央丘脑（CT），两者都承认他们在调节意识方面的作用。然而,在不同的研究中也探索了其他目标。刺激频率主要设置在25或100Hz，脉冲宽度为120μs，电压范围为0至4V。这些参数是根据个体患者的反应和评估定制的。所有纳入研究的临床总有效率为39.7%,表明DBS在部分DOC患者中具有积极作用。尽管如此，评估方法，随访持续时间，结果测量因研究而异，可能导致报告的有效率差异。
结论：尽管缺乏标准化参数带来了挑战，DBS作为DOC患者的治疗选择显示出很有希望的潜力。然而,仍然需要标准化的协议和评估方法，这对于加深理解和优化DBS在这一特定患者人群中的治疗潜力至关重要。
