Altinel Yuksel, Alkhalfan Fahad, Qiao Nidan, Velimirovic Marko
Medical Sciences in Clinical Investigation, Harvard Medical School, Boston, Massachusetts, USA.
Medical Sciences in Clinical Investigation, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
World Neurosurg. 2019 Mar;123:443-452.e8. doi: 10.1016/j.wneu.2018.11.175. Epub 2018 Nov 27.
Optimal surgical strategy for patients with tremor remains uncertain. We conducted a systematic review and meta-analysis evaluating randomized controlled trials of deep brain stimulation (DBS) and lesion surgery (LS) in the treatment of tremor.
We searched PubMed, Embase, and the Cochrane database to include randomized clinical trials with either LS, deep brain stimulation, or controls. The outcomes were the change in tremor score, quality of life, cognitive function, and neuropsychiatric function. We used standardized mean differences (SMDs) to pool the outcomes.
Fifteen trials, including 1508 patients, met eligibility criteria. We observed no significant difference in change of tremor scale (SMD -0.07, 95% confidence interval [CI]: -0.38 to 0.24), quality of life (SMD -0.21, 95% CI: -0.69 to 0.27), cognitive function (SMD 0.06, 95% CI: -0.27 to 0.39), or neuropsychiatric function (SMD -0.15, 95% CI: -0.49 to 0.19) between LS and stimulation surgery. We observed heterogeneity across studies during indirect comparison of quality of life. We identified a possible effect modifier: improvement in quality of life correlated with duration of disease (P = 0.035). We found that focused-ultrasound LS was associated with a 0.70 SMD increase (P = 0.014) in quality of life versus DBS in an exploratory subgroup analysis by separating 2 studies with focused-ultrasound LS from other LS studies.
Although the main analysis showed that LS and DBS were equally effective in the treatment of patients with tremor, an exploratory subgroup analysis indicated an improvement in quality of life with noninvasive focused-ultrasound surgery.
震颤患者的最佳手术策略仍不明确。我们进行了一项系统评价和荟萃分析，评估深部脑刺激（DBS）和毁损手术（LS）治疗震颤的随机对照试验。
我们检索了PubMed、Embase和Cochrane数据库，纳入了采用LS、深部脑刺激或对照的随机临床试验。结局指标为震颤评分、生活质量、认知功能和神经精神功能的变化。我们使用标准化均数差（SMD）汇总结局指标。
15项试验，共1508例患者，符合纳入标准。我们观察到，在震颤量表变化（SMD -0.07，95%置信区间[CI]：-0.38至0.24）、生活质量（SMD -0.21，95% CI：-0.69至0.27）、认知功能（SMD 0.06，95% CI：-0.27至0.39）或神经精神功能（SMD -0.15，95% CI：-0.49至0.19）方面，LS与刺激手术之间无显著差异。在生活质量的间接比较中，我们观察到各研究之间存在异质性。我们确定了一个可能的效应修饰因素：生活质量的改善与疾病持续时间相关（P = 0.035）。在一项探索性亚组分析中，我们将2项采用聚焦超声LS的研究与其他LS研究分开，发现与DBS相比，聚焦超声LS使生活质量的SMD增加了0.70（P = 0.014）。
尽管主要分析表明LS和DBS在治疗震颤患者方面同样有效，但一项探索性亚组分析表明，非侵入性聚焦超声手术可改善生活质量。
