Background Deep brain stimulation(DBS)has been preliminarily applied to treat patients with disorders of consciousness(DoCs).The study aimed to determine whether DBS was effective for treating patients with DoC and id...Background Deep brain stimulation(DBS)has been preliminarily applied to treat patients with disorders of consciousness(DoCs).The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients’outcomes.Methods Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed.Multivariate regression and subgroup analysis were performed to adjust for potential confounders.The primary outcome was improvement in consciousness at 1 year.Results An overall improvement in consciousness at 1 year was achieved in 32.4%(12/37)of the DBS group compared with 4.3%(14/328)of the conservative group.After full adjustment,DBS significantly improved consciousness at 1 year(adjusted OR 11.90,95%CI 3.65-38.46,p<0.001).There was a significant treatment×follow up interaction(H=14.99,p<0.001).DBS had significantly better effects in patients with minimally conscious state(MCS)compared with patients with vegetative state/unresponsive wakefulness syndrome(p for interaction<0.001).A nomogram based on age,state of consciousness,pathogeny and duration of DoCs indicated excellent predictive performance(c-index=0.882).Conclusions DBS was associated with better outcomes in patients with DoC,and the effect was likely to be significantly greater in patients with MCS.DBS should be cautiously evaluated by nomogram preoperatively,and randomised controlled trials are still needed.展开更多
基金the following funding sources:the National Natural Science Foundation of China(81600919)Beijing Municipal Science and Technology Commission(Z161100000516165 and Z171100001017162)Beijing Nova Program(Z181100006218050).
文摘Background Deep brain stimulation(DBS)has been preliminarily applied to treat patients with disorders of consciousness(DoCs).The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients’outcomes.Methods Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed.Multivariate regression and subgroup analysis were performed to adjust for potential confounders.The primary outcome was improvement in consciousness at 1 year.Results An overall improvement in consciousness at 1 year was achieved in 32.4%(12/37)of the DBS group compared with 4.3%(14/328)of the conservative group.After full adjustment,DBS significantly improved consciousness at 1 year(adjusted OR 11.90,95%CI 3.65-38.46,p<0.001).There was a significant treatment×follow up interaction(H=14.99,p<0.001).DBS had significantly better effects in patients with minimally conscious state(MCS)compared with patients with vegetative state/unresponsive wakefulness syndrome(p for interaction<0.001).A nomogram based on age,state of consciousness,pathogeny and duration of DoCs indicated excellent predictive performance(c-index=0.882).Conclusions DBS was associated with better outcomes in patients with DoC,and the effect was likely to be significantly greater in patients with MCS.DBS should be cautiously evaluated by nomogram preoperatively,and randomised controlled trials are still needed.
