RESUMO
BACKGROUND: For more than 30 years, deep brain stimulation (DBS) has been a therapeutic tool for Parkinson's disease (PD) treatment. DBS can ameliorate several motor and non-motor symptoms and improve the patients' quality of life. OBJECTIVES: To analyze the global scientific production of original and review articles on Parkinson's disease treatment using deep brain stimulation. DESIGN AND SETTING: Descriptive, bibliometric study with a quantitative approach. METHOD: The research protocol was conducted in March 2023 using the Web of Science database. Six hundred eighty-four articles were included in the analysis. Data were imported into RStudio Desktop Software, linked to R Software. The Bibliometrix R package, its Biblioshiny web interface, and VOSviewer software were used for the analysis. RESULTS: The international production began in 1998. Movement Disorders is the journal with the largest number of published articles and the most cited. Michael Okun and Andres Lozano are the authors who produced the most in this area. The University of Florida is the most active affiliated institution in Brazil. The United States has the largest number of collaborations and is mainly published by local researchers. In contrast, countries such as the United Kingdom and Canada have a high number of multi-country publications. The 15 most cited studies predominantly investigated subthalamic nucleus stimulation. CONCLUSION: DBS for Parkinson's disease is a relatively novel therapeutic approach, with studies that have expanded over the last twenty-five years. Most scientific production was quantitative and restricted to specialized journals. The United States, Europe, and China held the most articles.
Assuntos
Bibliometria , Estimulação Encefálica Profunda , Doença de Parkinson , Estimulação Encefálica Profunda/estatística & dados numéricos , Estimulação Encefálica Profunda/métodos , Humanos , Doença de Parkinson/terapiaRESUMO
El núcleo pedunculopontmo contiene gran cantidad de conexiones que modulan la actividad motora en los humanos; por este motivo, se ha planteado que su estimulación profunda tendría beneficios significativos en el tratamiento de la enfermedad de Parkinson. Con una carga orgánica y social significativa, la enfermedad de Parkinson reúne una serie de signos y síntomas, principalmente motores, que afectan significativamente la calidad de vida de los pacientes que la padecen. Actualmente, se encuentran dentro de un área de investigación con gran potencial para dar manejo a los síntomas de esta enfermedad, y se desconoce si su estimulación cerebral profunda podría orientar futuras intervenciones con resultados óptimos. Por esta razón, la revisión busca esclarecer la utilidad de este procedimiento; sin embargo, es bastante controvertido y su evidencia escasa, además de que es difícil centrarse únicamente en un núcleo para resolver los problemas relacionados con dicha enfermedad.
The pendunculopontine nucleus contains many connections responsible or modulate motor activity. It has been suggested that deep stimulation would have significant benefits in the treatment of Parldnson's disease, intervention that could improve the patient5s quality of life and generare a positive impact in public health due Parkmson's disease has important organic and social burden. There is a growmg area of research in this fíeld, however is still uncertain if deep brain stimulation could guide future interventíons with optimal results. For this reason, we pretend to darify the existing knowledge of this procedure, nevertheless, it is quite controversial, we consider that it is difficult to focusing on a unique nucleus to solve the problems associated with this disease.
Assuntos
Doença de Parkinson/diagnóstico , Núcleo Tegmental Pedunculopontino/fisiopatologia , Estimulação Encefálica Profunda/estatística & dados numéricosRESUMO
BACKGROUND: Parkinson disease (PD) is a chronic multifaceted neurodegenerative disorder of adult onset that affects quality of life and places a burden on patients, caregivers, and society. In early disease, dopaminergic therapy improves motor symptoms, but as the disease progresses, symptoms tend to increase in frequency and severity, even with best medical treatment (BMT). Deep brain stimulation (DBS) becomes an option for certain patients, but cost becomes an important issue. OBJECTIVE: We performed a systematic review of the literature of economic studies of the use of DBS in patients with PD, including costs studies or economic evaluations expressed as cost per improvement in quality life, decrease in dose of pharmacological treatments, and the decrease of caregiver burden. METHODS: We reviewed the following databases: Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform ICTRP portal and ClinicalTrials.gov from 1980 to 2015. Costs have been converted or adjusted to 2016 US dollars (US$). RESULTS: Nine studies were identified. The average cost of DBS for a patient with PD in 5 years is US$186,244. The quality-adjusted life year was higher in DBS compared with BMT after at least 2 years of treatment, with an average incremental cost utility ratio of US$41,932 per additional quality-adjusted life year gained. Costs in the first year are higher with DBS because of direct costs related to the surgical procedure, the device, and the more frequent controls. Studies show better results with a longer time horizon (up to 5 years). CONCLUSION: DBS is a cost-effective intervention for patients with advanced PD, but it has a high initial cost compared with BMT. However, DBS reduces pharmacologic treatment costs and should also reduce direct, indirect, and social costs of PD on the long term.
Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Estimulação Encefálica Profunda/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Doença de Parkinson/economia , Doença de Parkinson/terapia , Antiparkinsonianos/economia , Antiparkinsonianos/uso terapêutico , Cuidadores/estatística & dados numéricos , Terapia Combinada/economia , Terapia Combinada/estatística & dados numéricos , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricos , Estimulação Encefálica Profunda/estatística & dados numéricos , Humanos , Internacionalidade , Doença de Parkinson/mortalidade , Prevalência , Qualidade de Vida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
O objetivo deste estudo foi verificar o efeito da estimulação fótica-auditiva, sem qualquer outro tipo de intervenção fisioterapêutica ou motriz, sobre domínios que marcantemente influenciam o cotidiano de indivíduos idosos. A metodologia abrangeu um procedimento de teste e (re)teste, com a utilização do questionário SF-36, que examina aqueles domínios que se relacionam a níveis de capacidade funcional, saúde mental, vitalidade, dor e estado geral. A amostra incluiu 08 indivíduos idosos moradores de uma cidade do interior do estado do Rio de Janeiro, que receberam, entre o teste e o re-teste, 05 sessões de estimulação fótica-auditiva em uma sessão pré-programada especificamente para proporcionar estado de bem estar. Os resultados mostraram que a estimulação não apresentou efeitos significativos entre o pré e o pós-teste, sendo p > 0,05 para todos os domínios verificados. Conclui-se que a quantidade de sessões de estimulação não foi suficiente para produção dos efeitos esperados sobre os domínios estudados. Apontou-se, ainda, na discussão destes resultados, que provavelmente a ausência de uma estratégia associada à experiência neural possa ter sido o principal motivo para que a estimulação não procedesse em benefícios funcionais, como os que são observados quando do mesmo tipo de estimulação com o uso conjugado de técnicas de imagética.
The aim of this study was to evaluate the effect of stimulation by light and sound, without any other intervention or physical therapy on the marked areas that affect the daily life of elderly individuals. The methodology was through test and retest, which applied the SF-36 in the functional capacity, mental health, vitality, pain and general condition. The sample was 08 elderly residents of a city in the state of Rio de Janeiro, who received 05 sessions of the stimulation by light and between the test and re-test sound and one session dedicated to provide state of well being. The outcomes showed that the cortical stimulation has no significant effects between the pre and post-test. It is concluded that 05 sessions of cortical stimulation produced no significant effects in the areas studied. Showed up even in discussion of these results, probably the lack of a strategy linked to neural experience may have been the main reason for the stimulation does not carry on functional benefits, such as those observed when the same type of stimulation in conjunction with the use of imagetic techniques.