Bratsos Sosipatros, Karponis Dimitrios, Saleh Sohag N
Internal Medicine, Imperial College London, London, GBR.
Orthopaedics, Imperial College London, London, GBR.
Cureus. 2018 Oct 22;10(10):e3474. doi: 10.7759/cureus.3474.
Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson's disease (PD). Whether similar benefits may be realized by patients with early PD, however, is currently unclear, especially given the potential risks of the procedure. This systematic review and meta-analysis aimed to investigate the relative efficacy and safety of DBS in comparison to best medical therapy (BMT) in the treatment of PD. It also aimed to compare the efficacy of DBS between patients with early and advanced PD. A systematic search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) comparing DBS to BMT in PD patients were included. Outcome measures were impairment/disability using the Unified Parkinson's Disease Rating Scale (UPDRS), quality of life (QoL) using the Parkinson's Disease Questionnaire (PDQ-39), levodopa equivalent dose (LED) reduction, and rates of serious adverse events (SAE). Eight eligible RCTs (n = 1,189) were included in the meta-analysis, two of which recruited early PD patients. Regarding efficacy outcomes, there were significant improvements in UPDRS, PDQ-39, and LED scores in favour of DBS (P < 0.00001). There was a significantly greater reduction of LED in patients with early PD (P < 0.00001), but no other differences between early and advanced PD patients were found. The risk of a patient experiencing an SAE was significantly higher in the DBS group (P = 0.005), as was the total number of SAEs (P < 0.00188). Overall, DBS was superior to BMT at improving impairment/disability, QoL, and reducing medication doses, but these benefits need to be weighed against the higher risk of SAEs. There was insufficient evidence to determine the impact of the PD stage on the efficacy of DBS.
脑深部电刺激术（DBS）是一种适用于晚期帕金森病（PD）患者的神经外科手术。然而，早期PD患者是否能获得类似的益处目前尚不清楚，尤其是考虑到该手术存在的潜在风险。本系统评价和荟萃分析旨在研究DBS与最佳药物治疗（BMT）相比在治疗PD中的相对疗效和安全性。它还旨在比较早期和晚期PD患者接受DBS的疗效。我们在Medline、Embase和Cochrane对照试验中央注册库（CENTRAL）中进行了系统检索。纳入了比较PD患者DBS与BMT的随机对照试验（RCT）。结局指标包括使用统一帕金森病评定量表（UPDRS）评估的损伤/残疾情况、使用帕金森病问卷（PDQ-39）评估的生活质量（QoL）、左旋多巴等效剂量（LED）的降低以及严重不良事件（SAE）的发生率。荟萃分析纳入了8项符合条件的RCT（n = 1189），其中两项纳入了早期PD患者。关于疗效结局，UPDRS、PDQ-39和LED评分均有显著改善，支持DBS（P < 0.00001）。早期PD患者的LED降低幅度显著更大（P < 0.00001），但未发现早期和晚期PD患者之间的其他差异。DBS组患者发生SAE的风险显著更高（P = 0.005），SAE的总数也是如此（P < 0.00188）。总体而言，在改善损伤/残疾、QoL和减少药物剂量方面，DBS优于BMT，但这些益处需要与更高的SAE风险相权衡。没有足够的证据来确定PD分期对DBS疗效的影响。
