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脊髓刺激治疗帕金森病步态障碍。

Spinal Cord Stimulation for Gait Disorders in Parkinson's Disease.

机构信息

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.

出版信息

J Parkinsons Dis. 2023;13(1):57-70. doi: 10.3233/JPD-223284.


DOI:10.3233/JPD-223284
PMID:36683516
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9912734/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e8f/9912734/0e2a6c252342/jpd-13-jpd223284-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e8f/9912734/0e2a6c252342/jpd-13-jpd223284-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e8f/9912734/0e2a6c252342/jpd-13-jpd223284-g001.jpg

相似文献

[1]
Spinal Cord Stimulation for Gait Disorders in Parkinson's Disease.

J Parkinsons Dis. 2023

[2]
Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait.

Elife. 2018-8-2

[3]
Spinal cord stimulation for the treatment of abnormal posture and gait disorder in patients with Parkinson's disease.

Neurol Med Chir (Tokyo). 2012

[4]
Spinal Cord Stimulation with Surgical Lead Improves Pain and Gait in Parkinson's Disease after a Dislocation of Percutaneous Lead: A Case Report.

Stereotact Funct Neurosurg. 2020

[5]
Transcutaneous magnetic spinal cord stimulation for freezing of gait in Parkinson's disease.

J Clin Neurosci. 2020-11

[6]
Fields of Forel Brain Stimulation Improves Levodopa-Unresponsive Gait and Balance Disorders in Parkinson's Disease.

Neurosurgery. 2021-8-16

[7]
Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation.

Mov Disord. 2017-2

[8]
Spinal Cord Stimulation Therapy for Gait Dysfunction in Advanced Parkinson's Disease Patients.

Mov Disord. 2018-2-14

[9]
Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients.

J Neurol. 2021-3

[10]
Spinal cord stimulation for Parkinson's disease: a systematic review.

Neurosurg Rev. 2016-1

引用本文的文献

[1]
Restless legs syndrome in Parkinson's disease: epidemiology, pathogenetic overlaps, and clinical management.

J Neurol. 2025-8-11

[2]
Predictive model for the therapeutic effect of bilateral subthalamic nucleus deep brain stimulation on the freezing of gait in Parkinson's disease.

Front Aging Neurosci. 2025-5-27

[3]
A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies.

Mov Disord Clin Pract. 2024-8

[4]
Effects of Trans-Spinal Magnetic Stimulation on DBS' Induced Freezing of Gait in a Patient with Generalized Dystonia.

Mov Disord Clin Pract. 2024-9

[5]
Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter.

Clin Neurophysiol. 2024-8

[6]
A spinal cord neuroprosthesis for locomotor deficits due to Parkinson's disease.

Nat Med. 2023-11

本文引用的文献

[1]
Management of Chronic and Neuropathic Pain with 10 kHz Spinal Cord Stimulation Technology: Summary of Findings from Preclinical and Clinical Studies.

Biomedicines. 2021-6-4

[2]
Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial.

JAMA Neurol. 2021-6-1

[3]
Trans-Spinal Direct Current Stimulation for Managing Primary Orthostatic Tremor.

Mov Disord. 2021-8

[4]
Gait Analysis in Parkinson's Disease: An Overview of the Most Accurate Markers for Diagnosis and Symptoms Monitoring.

Sensors (Basel). 2020-6-22

[5]
The revised Cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application.

J Clin Epidemiol. 2020-10

[6]
Spinal Cord Stimulation with Surgical Lead Improves Pain and Gait in Parkinson's Disease after a Dislocation of Percutaneous Lead: A Case Report.

Stereotact Funct Neurosurg. 2020

[7]
Freezing of Gait can persist after an acute levodopa challenge in Parkinson's disease.

NPJ Parkinsons Dis. 2019-11-22

[8]
Epidural Spinal Cord Stimulation Improves Motor Function in Rats With Chemically Induced Parkinsonism.

Neurorehabil Neural Repair. 2019-11-5

[9]
Postural Instability in Parkinson's Disease: A Review.

Brain Sci. 2019-9-18

[10]
Spinal Cord Stimulation for Freezing of Gait: From Bench to Bedside.

Front Neurol. 2019-8-27

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