Chen Tianyi, Lin Fabin, Cai Guoen
School of Mathematics, Shandong University, Jinan, China.
Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China.
Front Hum Neurosci. 2021 Oct 22;15:749722. doi: 10.3389/fnhum.2021.749722. eCollection 2021.
Although a variety of targets for deep brain stimulation (DBS) have been found to be effective in Parkinson's disease (PD), it remains unclear which target for DBS leads to the best improvement in gait disorders in patients with PD. The purpose of this network meta-analysis (NMA) is to compare the efficacy of subthalamic nucleus (STN)-DBS, internal globus pallidus (GPi)-DBS, and pedunculopontine nucleus (PPN)-DBS, in improving gait disorders in patients with PD. We searched the PubMed database for articles published from January 1990 to December 2020. We used various languages to search for relevant documents to reduce language bias. A Bayesian NMA and systematic review of randomized and non-randomized controlled trials were conducted to explore the effects of different targets for DBS on gait damage. In the 34 included studies, 538 patients with PD met the inclusion criteria. The NMA results of the effect of the DBS "on and off" on the mean change of the gait of the patients in medication-off show that GPi-DBS, STN-DBS, and PPN-DBS are significantly better than the baseline [GPi-DBS: -0.79(-1.2, -0.41), STN-DBS: -0.97(-1.1, -0.81), and PPN-DBS: -0.56(-1.1, -0.021)]. According to the surface under the cumulative ranking (SUCRA) score, the STN-DBS (SUCRA = 74.15%) ranked first, followed by the GPi-DBS (SUCRA = 48.30%), and the PPN-DBS (SUCRA = 27.20%) ranked last. The NMA results of the effect of the DBS "on and off" on the mean change of the gait of the patients in medication-on show that, compared with baseline, GPi-DBS and STN-DBS proved to be significantly effective [GPi-DBS: -0.53 (-1.0, -0.088) and STN-DBS: -0.47(-0.66, -0.29)]. The GPi-DBS ranked first (SUCRA = 59.00%), followed by STN-DBS(SUCRA = 51.70%), and PPN-DBS(SUCRA = 35.93%) ranked last. The meta-analysis results show that both the STN-DBS and GPi-DBS can affect certain aspects of PD gait disorder.
尽管已发现多种用于深部脑刺激（DBS）的靶点在帕金森病（PD）中有效，但尚不清楚哪种DBS靶点能使PD患者的步态障碍得到最佳改善。这项网络荟萃分析（NMA）的目的是比较丘脑底核（STN）-DBS、苍白球内侧部（GPi）-DBS和脚桥核（PPN）-DBS在改善PD患者步态障碍方面的疗效。我们在PubMed数据库中检索了1990年1月至2020年12月发表的文章。我们使用多种语言检索相关文献以减少语言偏倚。进行了贝叶斯NMA以及对随机和非随机对照试验的系统评价，以探讨不同DBS靶点对步态损害的影响。在纳入的34项研究中，538例PD患者符合纳入标准。DBS“开”和“关”对未用药患者步态平均变化影响的NMA结果显示，GPi-DBS、STN-DBS和PPN-DBS均显著优于基线[GPi-DBS：-0.79（-1.2，-0.41），STN-DBS：-0.97（-1.1，-0.81），PPN-DBS：-0.56（-1.1，-0.021）]。根据累积排序曲线下面积（SUCRA）评分，STN-DBS（SUCRA = 74.15%）排名第一，其次是GPi-DBS（SUCRA = 48.30%），PPN-DBS（SUCRA = 27.20%）排名最后。DBS“开”和“关”对用药患者步态平均变化影响的NMA结果显示，与基线相比，GPi-DBS和STN-DBS被证明显著有效[GPi-DBS：-0.53（-1.0，-0.088），STN-DBS：-0.47（-0.66，-0.29）]。GPi-DBS排名第一（SUCRA = 59.00%），其次是STN-DBS（SUCRA = 51.70%），PPN-DBS（SUCRA = 35.93%）排名最后。荟萃分析结果表明，STN-DBS和GPi-DBS均可影响PD步态障碍的某些方面。
