Wang Jia-Wei, Zhang Yu-Qing, Zhang Xiao-Hua, Wang Yun-Peng, Li Ji-Ping, Li Yong-Jie
Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
World Neurosurg. 2017 Jun;102:72-78. doi: 10.1016/j.wneu.2017.02.110. Epub 2017 Mar 6.
Postural instability and gait disorder (PIGD) in Parkinson disease (PD) has been a great challenge in clinical practice because PIGD is closely linked to major morbidity and mortality in PD. Pedunculopontine nucleus (PPN) has been considered as a potential promising target for deep brain stimulation (DBS) in the treatment of PIGD. A meta-analysis of individual patient data was performed to assess the effects of PPN DBS on PIGD in patients with PD and explore the factors predicting good outcome.
According to the study strategy, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, and other sources. After searching the literature, 2 investigators independently screened the literature, assessed the quality of the included trials, and extracted the data. The outcome measures included PIGD, freezing of gait, and falling in PD. Then, individual patient data were incorporated into SPSS software for statistical analyses across series.
Six studies reporting individual patient data were included for final analysis. PPN DBS significantly improved PIGD as well as freezing of gait and falling after PD, which was depending on the duration of follow-up and types of outcome measures. In addition, patient age, disease duration, levodopa-equivalent dosage, and the choice of unilateral or bilateral stimulation were similar in groups of patients with PD with or without improvement in PIGD after PPN DBS.
Our study provides evidence that PPN DBS may improve PIGD, which should be interpreted with caution and needs further verification before making generalization of our results.
帕金森病（PD）中的姿势不稳和步态障碍（PIGD）一直是临床实践中的重大挑战，因为PIGD与PD的主要发病率和死亡率密切相关。脚桥核（PPN）被认为是深部脑刺激（DBS）治疗PIGD的一个潜在有前景的靶点。进行了一项个体患者数据的荟萃分析，以评估PPN DBS对PD患者PIGD的影响，并探索预测良好结局的因素。
根据研究策略，我们检索了PubMed、Embase和Cochrane对照试验中央注册库以及其他来源。检索文献后，2名研究者独立筛选文献、评估纳入试验的质量并提取数据。结局指标包括PIGD、步态冻结和PD中的跌倒。然后，将个体患者数据纳入SPSS软件进行系列间的统计分析。
纳入6项报告个体患者数据的研究进行最终分析。PPN DBS显著改善了PIGD以及PD后的步态冻结和跌倒，这取决于随访时间和结局指标的类型。此外，PPN DBS后PIGD改善或未改善的PD患者组在患者年龄、病程、左旋多巴等效剂量以及单侧或双侧刺激的选择方面相似。
我们的研究提供了证据表明PPN DBS可能改善PIGD，但在推广我们的结果之前，应谨慎解释并需要进一步验证。
