Estimulación cerebral profunda versus estimulación del nervio vago en el tratamiento de la depresión resistente a la terapia: una revisión sistemática y un metanálisis

Abstract

Introduction: “Depression” represents a group of heterogeneous clinical conditions that imposes a serious public health problem. The WHO estimates that depression will be the third leading cause of debilitating diseases by 2030. The established treatment involves antidepressants, psychotherapy, electroconvulsive therapy and transcranial magnetic stimulation. 10 to 20% of patients are depressants resistant to conventional treatments (TRD) and for these, modern psychosurgery is becomingpart of the therapeutic arsenal. This paper analyzes the current evidence and the potential for the application of vagal nerve stimulation (VNS) and deep brain stimulation (DBS) in the subgenual cingulate cortex (SCC) in the treatment of depression. Material and Methods: A systematic review of the prospective clinical trials conducted in American and European centers byMedline / Pubmed between 2000 and 2016, with p 10, with a review of the references cited by all relevant localized studies. We obtained 66 references for VNS and 137 for DBS, ten studies of VNS and three of DBS were selected according to eligibility criteria. An exploratory meta-analysis was performed through the event rates found. Results: A sample of 643 patients with TRD was obtained in the VNS and 58 DBS studies. The VNS response rate after 12 months was 42.0% (95% CI= 31.2% to 56.7%) and the remission rate was 22.3% (95% CI = 16.5% to 30.0%). DBS rates were 37.0% (95% CI = 22.9% to 59.6%) and 26.2% (95% CI = 15.4% to 44.5%) respectively. Conclusion: Individual analysis of clinical trials demonstrates that both VNS and DBS are promising resources in the treatment of TRD, especially in the short and medium term, however most studies are not randomized. The meta-analysis revealed high heterogeneity due to the reduced number of clinical trials, technical differences and selection bias.