Effect of Deep Brain Stimulation on Comorbid Self-injurious Behavior: A Systematic Review and Meta-analysis of Individual Patient Data.

Autor: Mithani K; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada., Zhang K; Institute of Medical Sciences, University of Toronto, Toronto, Canada., Yan H; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada; Institute of Health of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada., Elkaim L; Department of Neurosurgery, McGill University, Montreal, Canada., Gariscsak PJ; School of Medicine, Queen's University, Kingston, Canada., Suresh H; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada., Gouveia FV; Neurosciences and Mental Health, SickKids Research Institute, Toronto, Canada., Fasano A; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Canada., Gorodetsky C; Division of Neurology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada., Ibrahim GM; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada; Neurosciences and Mental Health, SickKids Research Institute, Toronto, Canada. Electronic address: george.ibrahim@sickkids.ca.
Jazyk: angličtina
Zdroj: Neuromodulation : journal of the International Neuromodulation Society [Neuromodulation] 2024 Sep 20. Date of Electronic Publication: 2024 Sep 20.
DOI: 10.1016/j.neurom.2024.07.009
Abstrakt: Objective: Self-injurious behavior (SIB) can occur in the setting of many neurologic disorders that are amenable to deep brain stimulation (DBS). Although certain brain targets are believed to be particularly effective for SIB, improvements in the primary neurologic condition may also reduce co-occurring SIB. We performed a systematic review and meta-analysis of individual participant data to characterize the effects of DBS across various neurologic disorders and brain targets on comorbid SIB.
Materials and Methods: A systematic review of all available literature on DBS in treating disorders with co-occurring SIB was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Individual participant data were extracted and standardized mean differences (SMDs) in metrics of SIB severity and/or frequency were calculated for meta-analysis. Demographic variables and adverse events were also collated.
Results: Data from 59 patients, identified from 24 articles, with comorbid SIB who underwent DBS for various indications were extracted. The primary neurologic diagnoses included Tourette syndrome (n = 40), dystonia (n = 7), epilepsy (n = 5), acquired brain injury (n = 3), dyskinesia (n = 2), and obsessive-compulsive disorder (n = 2). Overall, DBS was highly effective in treating comorbid SIB (Mean SMD = -2.4, p < 0.0001) across primary disorders and intracranial targets. Patients with dystonia and DBS targeting the posterior hypothalamus had relatively less success at mitigating comorbid SIB.
Conclusions: In patients with comorbid SIB, DBS to treat the primary neurologic condition may also mitigate SIB. Although several targets are emerging for the treatment of severe SIB, this work suggests that DBS targeting the primary neurologic condition should be first considered in comorbid SIB.
Competing Interests: Conflict of Interest Alfonso Fasano received honoraria and research funding from Medtronic and receives consulting fees from Medtronic, Abbvie, Boston Scientific, Brainlab, and Ipsen. Carolina Gorodetsky received honoraria from Medtronic. George M. Ibrahim receives investigator-initiated grant funding, speaking and consulting fees from LivaNova Inc, consulting fees from Synergia Inc, and consulting fees from Medtronic. The remaining authors report no conflict of interest.
(Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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