Revisão de escopo sobre o uso da estimulação cerebral profunda no tratamento da distonia
Data
2022-02-10
Autores
Nonato, Ísis Nalin Fernandes [UNIFESP]
Orientadores
Melo, Daniela Oliveira [UNIFESP]
Tipo
Trabalho de conclusão de curso de graduação
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Nas últimas duas décadas, a neuromodulação tem testemunhado avanços significativos no desenvolvimento de tecnologias, como a estimulação cerebral profunda (DBS), que vem sendo utilizada e amplamente estudada como uma opção de tratamento alternativo especialmente em pacientes com distonia refratária a terapia convencional. Objetivo: Mapear estudos de diferentes delineamentos sobre o uso da estimulação cerebral profunda no tratamento de distonias. Materiais e métodos: Os artigos foram coletados nas bases de dados MEDLINE (via Pubmed), EMBASE, Cochrane Library e LILACS, IBECS, BRISA (via BVS), com ausência de restrição quanto ao idioma, período, tipo de estudo ou status de publicação. Foram consideradas elegíveis apenas as publicações que avaliavam o uso da estimulação cerebral profunda no tratamento de todos os tipos de distonia. Posteriormente, as principais informações foram estratificadas de acordo com as características dos estudos e das distonias identificadas para avaliação. Resultados: Após a avaliação de 4.133 publicações, foram incluídas 207 publicações. Destas, 197 publicações de estudos primários e 10 de estudos secundários. Com relação aos estudos primários, 178 correspondiam a estudos observacionais e 19 a estudos experimentais. Foram identificadas 10 revisões sistemáticas onde 5 possuíam metanálise e 5 apresentaram síntese apenas descritiva. Entre os estudos primários secundários elegíveis, 139 envolveram pacientes com distonia primária, especialmente associada à mutação TOR1A (DYT1). Apenas 68 estudos envolveram pacientes com distonia secundária, que em sua maioria avaliaram pacientes com distonia induzida por medicamentos, doenças metabólicas, e paralisia cerebral. Discussão e conclusão: Foi possível perceber que um dos principais objetivos dos estudos encontrados é a avaliação de quais pacientes são mais propensos a obterem um maior benefício com a DBS. Estes estudos foram em sua maioria observacionais e avaliaram o uso da DBS em diferentes tipos de distonia, analisando potenciais fatores que influenciam na resposta do tratamento. Foram constatadas lacunas e discrepâncias em relação a quantidade de estudos que avaliavam algumas características específicas, especialmente em relação a etiologia, faixa etária, alvo e distribuição corporal, assim como a necessidade de mais estudos clínicos randomizados para garantia de maiores evidências em relação as hipóteses levantadas nos estudos observacionais referentes a eficácia e efeitos adversos, para uma melhor elegibilidade de pacientes.
Introduction: In the last two decades, neuromodulation has witnessed significant advances in the development of technologies, such as deep brain stimulation (DBS), which has been used and widely studied as an alternative treatment option especially in patients with dystonia refractory to conventional therapy. Objective: To map studies of different designs on the use of deep brain stimulation in the treatment of dystonias. Materials and methods: The articles were collected from MEDLINE (through Pubmed), EMBASE, Cochrane Library and LILACS, IBECS, BRISA (through BVS) databases, with no restrictions on language, period, type of study or publication status. Only publications that evaluated the use of deep brain stimulation in the treatment of all types of dystonia were considered eligible. Subsequently, the main information was stratified according to the characteristics of the studies and the dystonias identified for evaluation. Results: After evaluating 4,133 publications, 207 publications were included. Of these, 197 publications of primary studies and 10 of secondary studies. Regarding primary studies, 178 corresponded to observational studies and 19 to experimental studies. 10 systematic reviews were identified, 5 of which had a meta-analysis and 5 had only a descriptive synthesis. Among the eligible primary secondary studies, 139 involved patients with primary dystonia, especially associated with the TOR1A (DYT1) mutation. Only 68 studies involved patients with secondary dystonia, most of which evaluated patients with drug-induced dystonia, metabolic disorders, and cerebral palsy. Discussion and conclusion: It was possible to perceive that one of the main objectives of the studies found is the evaluation of which patients are more likely to obtain a greater benefit from DBS. These studies were mostly observational and evaluated the use of DBS in different types of dystonia, analyzing potential factors that influence treatment response. Gaps and discrepancies were found in relation to the number of studies that evaluated some specific characteristics, especially in relation to etiology, age group, target and body distribution, and also the need for more randomized clinical studies to guarantee greater evidence in relation to the hypotheses raised. in observational studies regarding efficacy and adverse effects, for better patient eligibility.
Introduction: In the last two decades, neuromodulation has witnessed significant advances in the development of technologies, such as deep brain stimulation (DBS), which has been used and widely studied as an alternative treatment option especially in patients with dystonia refractory to conventional therapy. Objective: To map studies of different designs on the use of deep brain stimulation in the treatment of dystonias. Materials and methods: The articles were collected from MEDLINE (through Pubmed), EMBASE, Cochrane Library and LILACS, IBECS, BRISA (through BVS) databases, with no restrictions on language, period, type of study or publication status. Only publications that evaluated the use of deep brain stimulation in the treatment of all types of dystonia were considered eligible. Subsequently, the main information was stratified according to the characteristics of the studies and the dystonias identified for evaluation. Results: After evaluating 4,133 publications, 207 publications were included. Of these, 197 publications of primary studies and 10 of secondary studies. Regarding primary studies, 178 corresponded to observational studies and 19 to experimental studies. 10 systematic reviews were identified, 5 of which had a meta-analysis and 5 had only a descriptive synthesis. Among the eligible primary secondary studies, 139 involved patients with primary dystonia, especially associated with the TOR1A (DYT1) mutation. Only 68 studies involved patients with secondary dystonia, most of which evaluated patients with drug-induced dystonia, metabolic disorders, and cerebral palsy. Discussion and conclusion: It was possible to perceive that one of the main objectives of the studies found is the evaluation of which patients are more likely to obtain a greater benefit from DBS. These studies were mostly observational and evaluated the use of DBS in different types of dystonia, analyzing potential factors that influence treatment response. Gaps and discrepancies were found in relation to the number of studies that evaluated some specific characteristics, especially in relation to etiology, age group, target and body distribution, and also the need for more randomized clinical studies to guarantee greater evidence in relation to the hypotheses raised. in observational studies regarding efficacy and adverse effects, for better patient eligibility.