帕金森病患者双侧脑深部刺激不同靶点和不同时期后的持续不良反应。
Persistent adverse effects following different targets and periods after bilateral deep brain stimulation in patients with Parkinson's disease.
机构信息
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China; The First Clinical Medical College of Nanchang University, Nanchang, China.
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China; The First Clinical Medical College of Nanchang University, Nanchang, China.
出版信息
J Neurol Sci. 2018 Oct 15;393:116-127. doi: 10.1016/j.jns.2018.08.016. Epub 2018 Aug 18.
BACKGROUND
Performed as one of the major treatments for advanced Parkinson's disease (PD), deep brain stimulation (DBS) surgery can induce adverse effects (AEs) on cognition, gait, mood, speech and swallowing, which are frequently reported and seriously affect the patient's daily life.
OBJECTIVE
To comprehensively analysis the adverse effect rates (AERs) of cognition, mood, gait, speech and swallowing after bilateral DBS in patients with PD.
METHOD
We performed a systematic search in PubMed, EMBASE and the Cochrane Library to collect all the articles reporting AEs after DBS in sufferers of PD. The cited articles were also manually searched.
RESULTS
A total of 31 articles were quantitatively analyzed. Random-effects models were used to calculate the AERs and 95% confidence intervals. Of all patients, the pooled AER of the five types of events was 24.0%. Specifically, the risks of cognition, mood and speech disturbance were higher after subthalamic nucleus (STN) -DBS than after globus pallidus interna (GPi) -DBS: 25.1% versus 14.6%, 26.3% versus 22.2% and 29.0% versus 19.6%, respectively. However, the AER of dysphagia was slightly lower after STN-DBS: 8.6% versus 10.1%. The risk of gait disorders was similar between two target groups in sub-analysis of random control trials (RCTs): 38.3% in STN group and 37.3% in GPi group. In three follow-up intervals, short-term follow-up (STF), mid-term follow-up (MTF) and long-term follow-up (LTF), gait (17.6%19.9%28.0%), speech (7.8%26.9%31.5%) and mood (7.4%24.9%30.7%) disorders worsened progressively. While cognitive disturbance (22.5%27.1%16.7%) reached its highest rate at MTF.
CONCLUSION
STN-DBS was 10% more likely to cause cognitive and speech disturbance than GPi-DBS, while STN-DBS had a lower risk of dysphagia. Two target groups had similar effects on gait. The pooled AER increased over time, while cognitive disturbance reached its highest rate at the 6- to 18-month follow-up. Additionally, speech and mood disturbance deteriorated rapidly from STF to MTF. Further investigation of the pathophysiology will help alleviate those AEs after DBS.
背景
深部脑刺激（DBS）手术作为治疗晚期帕金森病（PD）的主要方法之一，可能会对认知、步态、情绪、言语和吞咽产生不良影响（AEs），这些不良影响经常被报道，并严重影响患者的日常生活。
目的
全面分析双侧 DBS 治疗 PD 患者后认知、情绪、步态、言语和吞咽的不良效应发生率（AERs）。
方法
我们在 PubMed、EMBASE 和 Cochrane 图书馆中进行了系统检索，以收集所有报告 DBS 后 PD 患者发生 AE 的文章。还对引用的文章进行了手动检索。
结果
共有 31 篇文章进行了定量分析。采用随机效应模型计算 AERs 和 95%置信区间。在所有患者中，五类事件的总 AER 为 24.0%。具体来说，与苍白球内侧核（GPi）-DBS 相比，丘脑底核（STN）-DBS 后认知、情绪和言语障碍的风险更高：25.1%比 14.6%、26.3%比 22.2%和 29.0%比 19.6%。然而，STN-DBS 后吞咽困难的 AER 略低：8.6%比 10.1%。在随机对照试验（RCTs）的亚组分析中，两组之间步态障碍的风险相似：STN 组为 38.3%，GPi 组为 37.3%。在三个随访间隔（短期随访（STF）、中期随访（MTF）和长期随访（LTF））中，步态（17.6%19.9%28.0%）、言语（7.8%26.9%31.5%）和情绪（7.4%24.9%30.7%）障碍逐渐恶化。而认知障碍（22.5%27.1%16.7%）在 MTF 时达到最高。
结论
与 GPi-DBS 相比，STN-DBS 导致认知和言语障碍的可能性高 10%，而 STN-DBS 发生吞咽困难的风险较低。两个靶区对步态的影响相似。总体 AER 随时间增加，而认知障碍在 6 至 18 个月的随访中达到最高。此外，言语和情绪障碍从 STF 迅速恶化到 MTF。对病理生理学的进一步研究将有助于减轻 DBS 后的这些不良影响。
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