苍白球内侧部脑深部电刺激对帕金森病步态障碍的影响：文献的荟萃分析。
Effects of pedunculopontine nucleus deep brain stimulation on gait disorders in Parkinson's Disease: A meta-analysis of the literature.
机构信息
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China.
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China.
出版信息
Clin Neurol Neurosurg. 2020 Nov;198:106108. doi: 10.1016/j.clineuro.2020.106108. Epub 2020 Jul 29.
OBJECTIVES
The pedunculopontine nucleus (PPN) is considered a promising target to alleviate gait disorders. We aimed to evaluate the effects of PPN stimulation on motor symptoms and gait disorders in patients with Parkinson's disease (PD) to help assess the potential role of PPN-DBS treatment in gait disorders.
METHODS
Studies were searched for low-frequency PPN stimulation to treat gait disorders and freezing of gait (FOG) in the PubMed, Embase, Cochrane Library, Web of Science, and ClinicalKey up to April 2020. Outcomes of Unified Parkinson's Disease Rating Scale (UPDRS) part III, subitems 27-30; UPDRS subitems 13 and 14; the Freezing of Gait Questionnaire (FOGQ), and the Gait and Falls Questionnaire (GFQ) were extracted and evaluated during PPN On-stimulation compared to preoperation or Off-stimulation in both Off- and On-medication states.
RESULTS
There was a significant improvement in subitems 27-30 with PPN On-stimulation versus Off-stimulation in Off-medication and On-medication states, but no improvement in UPDRS part III. The occurrence of FOG and falls also declined between PPN On-stimulation and presurgery, with a significant improvement in subitem 13 and subitem 14 in Off-medication and On-medication states, GFQ, and FQGQ. Heterogeneity in stimulation frequency, follow-up, electrode location, and unilateral or bilateral stimulation existed among the included studies.
CONCLUSIONS
In some conditions and in some selective PD patients, low-frequency PPN-DBS has beneficial effects on FOG and falls but no wider benefits on rigidity, resting tremor, or bradykinesia.
目的
被盖核（PPN）被认为是缓解步态障碍的有前途的靶点。我们旨在评估 PPN 刺激对帕金森病（PD）患者运动症状和步态障碍的影响，以帮助评估 PPN-DBS 治疗在步态障碍中的潜在作用。
方法
在 2020 年 4 月之前，我们在 PubMed、Embase、Cochrane 图书馆、Web of Science 和 ClinicalKey 中搜索了用于治疗步态障碍和冻结步态（FOG）的低频 PPN 刺激的研究。提取并评估了统一帕金森病评定量表（UPDRS）第 3 部分的 27-30 项、第 13 和 14 项；冻结步态问卷（FOGQ）和步态和跌倒问卷（GFQ）在 PPN 刺激期间与术前或关闭刺激相比，在药物关闭和药物开启状态下。
结果
与药物关闭和药物开启状态下的关闭刺激相比，PPN 开启刺激时 27-30 项亚项显著改善，但 UPDRS 第 3 部分无改善。FOG 和跌倒的发生也在 PPN 开启刺激和术前之间减少，药物关闭和药物开启状态下的第 13 项和第 14 项、GFQ 和 FQGQ 均有显著改善。纳入研究之间的刺激频率、随访、电极位置、单侧或双侧刺激存在异质性。
结论
在某些情况下，在一些选择性 PD 患者中，低频 PPN-DBS 对 FOG 和跌倒有有益影响，但对僵硬、静止性震颤或运动迟缓没有更广泛的益处。
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