丘脑底核与苍白球内侧部脑深部电刺激改善晚期帕金森病异动症的随机对照试验的荟萃分析
STN versus GPi deep brain stimulation for dyskinesia improvement in advanced Parkinson's disease: A meta-analysis of randomized controlled trials.
作者信息
Zhang Junhuai, Li Jiayu, Chen Fang, Liu Xingzhi, Jiang Chun, Hu Xinghua, Ma Lin, Xu Zhongye
机构信息
Department of Neurosurgery, the First People's Hospital, Longquanyi District, Chengdu, No. 201, Group 3, Yihe, Longquanyi District, Chengdu City, Sichuan Province, People's Republic of China.
Department of Neurosurgery, Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), People's Republic of China.
出版信息
Clin Neurol Neurosurg. 2021 Feb;201:106450. doi: 10.1016/j.clineuro.2020.106450. Epub 2020 Dec 31.
BACKGROUND
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are currently the most common and effective surgical targets for advanced Parkinson's disease (APD). Herein, we conducted a meta-analysis to evaluate the comprehensive efficacy of STN-DBS and GPi-DBS in patients with APD.
METHODS
We conducted a systematic search for relevant articles written in English in the Cochrane Library, PubMed, and EMBASE databases through January 2020. Studies comparing the efficacy and clinical outcomes of GPi-DBS and STN-DBS for APD were included and analyzed.
RESULTS
Ten eligible trials with a total of 857 patients were included in this meta-analysis. The results showed no significant difference between the STN-DBS and GPi-DBS groups in Unified Parkinson's Disease Rating Scale (UPDRS) III scores during the on and off-medication phases(SMD, 0.1; 95 % CI, -0.04 to 0.25; p = 0.17, on-med), (SMD,-0.12;95 % CI -0.37 to 0.13, p = 0.33,off-med). Dyskinesia scores and the activities of daily living (ADLs) scores during the on-medication phase showed significant differences in favor of GPi stimulation (SMD, 0.16; 95 % CI, 0.01-0.32; P < 0.05)/(SMD, 0.18; 95 % CI, 0.01-0.34; P < 0.05). The ADLs score during the off-medication phase showed no significant difference between the STN-DBS and GPi-DBS groups (SMD, -0.11; 95 % CI, -0.32-0.11; P = 0.33). The LED showed significant differences in favor of STN stimulation (SMD, -0.57; 95 % CI, -0.74-0.40; P < 0.00001).
CONCLUSIONS
Both STN and GPi-DBS were equally effective in improving motor dysfunction. STN-DBS was superior for medication reduction, whereas GPi-DBS perhaps led to less dyskinesia and improved the postoperative ADLs (on-medication) in APD patients. Hence, the goals of DBS can be important in the target selection. More studies comparing the adverse events and quality of life between the two targets are needed.
背景
丘脑底核（STN）和内侧苍白球（GPi）的脑深部电刺激（DBS）目前是晚期帕金森病（APD）最常见且有效的手术靶点。在此，我们进行了一项荟萃分析，以评估STN-DBS和GPi-DBS对APD患者的综合疗效。
方法
我们在Cochrane图书馆、PubMed和EMBASE数据库中系统检索截至2020年1月用英文撰写的相关文章。纳入并分析比较GPi-DBS和STN-DBS治疗APD疗效和临床结局的研究。
结果
本荟萃分析纳入了10项符合条件的试验，共857例患者。结果显示，在服药期和未服药期，STN-DBS组和GPi-DBS组在统一帕金森病评定量表（UPDRS）III评分上无显著差异（标准化均数差[SMD]，0.1；95%置信区间[CI]，-0.04至0.25；P = 0.17，服药期），（SMD，-0.12；95% CI，-0.37至0.13；P = 0.33，未服药期）。服药期的异动症评分和日常生活活动（ADL）评分显示，GPi刺激有显著差异（SMD，0.16；95% CI，0.01 - 0.32；P < 0.05）/（SMD，0.18；95% CI，0.01 - 0.34；P < 0.05）。未服药期的ADL评分在STN-DBS组和GPi-DBS组之间无显著差异（SMD，-0.11；95% CI，-0.32 - 0.11；P = 0.33）。左旋多巴等效剂量（LED）显示，STN刺激有显著差异（SMD，-0.57；95% CI，-0.74至-0.40；P < 0.00001）。
结论
STN和GPi-DBS在改善运动功能障碍方面同样有效。STN-DBS在减少药物使用方面更具优势，而GPi-DBS可能导致较少的异动症，并改善APD患者术后的ADL（服药期）。因此，DBS的目标在靶点选择中可能很重要。需要更多比较两个靶点不良事件和生活质量的研究。
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