Unit of Functional Neurosurgery, Queen Square Institute of Neurology, University College London (UCL), London, UK.
Victor Horsley Department of Neurosurgery, the National Hospital for Neurology and Neurosurgery, University College London Hospitals (UCLH), Queen Square, London, UK.
J Parkinsons Dis. 2023;13(1):57-70. doi: 10.3233/JPD-223284.
BACKGROUND: Spinal cord stimulation (SCS) is a therapeutic procedure widely used in the management of refractory chronic pain. Evidence from case reports and small descriptive studies has emerged suggesting a role for SCS in patients with gait dysfunction, such as freezing of gait (FoG) and postural imbalance. These are severely debilitating symptoms of advanced Parkinson's disease (PD). OBJECTIVE: To establish the current evidence base for the potential application of SCS on gait and balance dysfunction in PD patients. METHODS: Three online databases were screened for relevant manuscripts. Two separate searches and four different search strategies were applied to yield relevant results. The main parameters of interest were postural and gait symptoms; secondary outcomes were Quality of Life (QoL) and adverse effects. RESULTS: Nineteen studies fulfilled the inclusion criteria. Motor improvements using section III of the Unified Parkinson's Disease Rating Score (UPDRS-III) were available in 13 studies. Measurements to assess FoG reported the following improvements: FoG questionnaires (in 1/19 studies); generalized freezing parameters (2); and walkway/wireless accelerometer measurements (2). Parameters of postural imbalance and falling improved as follows: BBS (1); posture sagittal vertical axis (1); and generalized data on postural instability (8). Two studies reported on adverse effects. QoL was shown to improve as follows: EQ-5D (2); ADL (1); SF-36 (1); BDI-II (1); PDQ-8 (1); HDRS (1); and VAS (5). CONCLUSION: SCS may have a therapeutic potential in advanced PD patients suffering from postural and gait-related symptoms. The existing evidence suggests that SCS positively affects patients' QoL with an acceptable safety profile in this patient population.
背景:脊髓刺激(SCS)是一种广泛用于治疗难治性慢性疼痛的治疗方法。来自病例报告和小型描述性研究的证据表明,SCS 对步态功能障碍患者具有作用,例如冻结步态(FoG)和姿势平衡障碍。这些是晚期帕金森病(PD)患者严重致残的症状。
目的:确定 SCS 在 PD 患者步态和平衡功能障碍中的潜在应用的当前证据基础。
方法:筛选了三个在线数据库以获取相关文献。应用了两种单独的搜索和四种不同的搜索策略来获得相关结果。主要关注的参数是姿势和步态症状;次要结果是生活质量(QoL)和不良反应。
结果:19 项研究符合纳入标准。使用统一帕金森病评定量表(UPDRS-III)的第 III 部分评估运动改善情况,有 13 项研究提供了结果。评估 FoG 的测量方法如下:FoG 问卷(在 1/19 项研究中);广义冻结参数(2);以及步行道/无线加速度计测量(2)。姿势失衡和跌倒的参数改善如下:BBS(1);姿势矢状垂直轴(1);和广义的姿势不稳定数据(8)。两项研究报告了不良反应。QoL 改善情况如下:EQ-5D(2);ADL(1);SF-36(1);BDI-II(1);PDQ-8(1);HDRS(1);和 VAS(5)。
结论:SCS 可能对患有姿势和步态相关症状的晚期 PD 患者具有治疗潜力。现有证据表明,SCS 对患者的 QoL 具有积极影响,并且在该患者人群中具有可接受的安全性。
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