Objective: Evaluate the effect of DBS on motor improvement in PSMD.

Background: Post-stroke movement disorders (PSMD) impair motor function and quality of life. Traditional rehabilitation often provides limited relief, prompting interest in alternative treatments like deep brain stimulation (DBS). While DBS is well-established for Parkinson’s disease, its role in PSMD remains underexplored.

Method: A systematic review was conducted using PubMed, Cochrane, and Embase with the keywords “post-stroke movement disorder” and “deep brain stimulation.” Eligible articles were case reports, observational studies, and clinical trials in English reporting DBS in PSMD. Systematic reviews, meta-analyses, and non-full-text articles were excluded.

Results: The search identified 940 studies, with 7 meeting inclusion criteria. A total of 23 patients underwent DBS for PSMD, primarily tremor (13 cases), dystonia (4), hemiballismus (4), spasticity (1), and hemichoreoathetosis (1). The DBS targets included the internal capsule (IC, 2 cases), ventral intermediate nucleus (Vim, 1), subthalamic nucleus (STN, 3), caudal zona incerta (cZi, 1), Vim/Vop (12), Voa/Vop (2), globus pallidus internus (GPi) and Vim (1), and Vo/Vim (1). Clinical response varied. One study¹ showed a 64.2% motor improvement on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and a 33.3% functional gain after three years. Another² reported a 60% reduction in hand/foot dystonia in one patient, while another had an 80–90% improvement in foot dystonia and 60% in the upper limb, enhancing independence. A study³ on post-stroke tremor found a significant reduction (p < 0.01) after one month, sustained for 24 months. Other studies⁴⁻⁷ confirmed long-term benefits, especially for tremor and dystonia. Adverse effects were mostly transient and related to programming adjustments, all managed via reprogramming. One study⁷ highlighted the need for stimulation adjustments over time.

Conclusion: DBS appears to offer substantial motor improvements in selected PSMD patients, particularly for tremor, dystonia, and hemiballismus. However, larger controlled trials are needed to refine patient selection, optimize stimulation parameters, and assess long-term outcomes. Future studies should identify predictors of response and standardize treatment protocols.

References: 1. KANTHARUBY TAMBIRAJOO et al. Subthalamic Nucleus Deep Brain Stimulation in Post-Infarct Dystonia. Stereotactic and Functional Neurosurgery, v. 98, n. 6, p. 386–398, 1 jan. 2020.
2. FRANZINI, A. et al. Deep brain stimulation for movement disorders. Considerations on 276 consecutive patients. Journal of Neural Transmission, v. 118, n. 10, p. 1497–1510, 19 maio 2011.
3. YAMAMOTO, T. et al. Deep brain stimulation for the treatment of parkinsonian, essential, and poststroke tremor: a suitable stimulation method and changes in effective stimulation intensity. Journal of Neurosurgery, v. 101, n. 2, p. 201–209, ago. 2004.
4. KOERBEL, A. et al. Treatment of Hemichoreoathetosis with Arrhythmic Proximal Tremor after Stroke: The Role of Zona Incerta as a Target for Deep Brain Stimulation. Journal of Movement Disorders, v. 12, n. 1, p. 47–51, 30 jan. 2019.
5. FRANZINI, A. et al. Deep brain stimulation in critical care conditions. Journal of Neural Transmission, v. 121, n. 4, p. 391–398, 30 nov. 2013.
6. PARKER, T. et al. Multitarget deep brain stimulation for clinically complex movement disorders. Journal of neurosurgery, v. 134, n. 2, p. 351–356, 4 jan. 2020.
7. KATAYAMA, Y. et al. Feed-forward control of post-stroke movement disorders by on-demand type stimulation of the thalamus and motor cortex. PubMed, p. 21–23, 25 jan. 2007.

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