Deep brain stimulation for post-stroke pain, cognitive and motor function rehabilitation: A comprehensive systematic review and meta-analysis on a novel approach

Background

Deep brain stimulation (DBS) is a neuromodulation technique used to treat various refractory conditions relating to movement disorders. It’s application in the stroke population has shown increasing interest in recent years, introducing promising initial results as a potential therapeutic modality for post-stroke rehabilitation.

Objectives

This systematic review and meta-analysis critically examine the efficacy and safety of DBS for post-stroke pain, cognitive and motor outcomes.

Methods

The study was registered in PROSPERO (Registration number CRD42024586415). Following PRISMA protocol, we systematically searched PubMed, EMBASE, CINAHL and Cochrane Library databases. The primary outcome was the effectiveness of DBS in improving pain and motor functions after stroke. Secondary outcomes were the effectiveness of DBS in improving cognitive function and post-intervention complications.

Results

The final quantitative synthesis included 10 studies reporting 109 patients. The overall pooled 1-year response rate was 0.82 [95% CI: 0.65 - 0.92] (p = 0.03), long-term response rate was 0.71 [95% CI: 0.32 - 0.92] (p < 0.01) on the random effects model. Reported overall procedural-related adverse events was 7% [95% CI: 0.04 - 0.15] and efficacy on chronic post-stroke pain VAS/BPI reduction was from 8.24 [95% CI: 7.55 - 8.72] at baseline to 4.60 [95% CI: 3.63 - 5.57], respectively (p < 0.01). A single-individual study on motor function recovery showed promising initial phase I trial results, with significant functional motor recovery and low rates of adverse events at 9%. Procedural-associated mortality was either not reported or not observed.

Conclusions

DBS is a promising and novel approach for post-stroke deficits rehabilitation. With prospective initial results, further high-quality randomized trials are needed to conclusively establish efficacy across diverse post-stroke conditions, particularly for motor function recovery.

Key points

• The study demonstrated a high 1-year response rate of 82% and a long-term response rate of 71%, defined as at least a 30% improvement in symptoms. DBS showed significant efficacy in alleviating chronic post-stroke pain (CPSP), improving motor functions, and enhancing cognitive outcomes.

• Deep Brain Stimulation exhibited a low adverse event rate of 7%, with no procedural-related mortality reported during an average follow-up period of 29.2 months.

• Despite promising results, the study emphasized the need for larger, high-quality randomized controlled trials to validate findings, particularly for motor recovery. Current evidence is still very limited, as reported by early-stage trials. Further exploration of clinical feasibility, cost-effectiveness, and quality-of-life impacts should be highly considered.