深部脑刺激治疗帕金森病中脊柱前屈畸形的疗效：系统评价和荟萃分析。

Efficacy of Deep Brain Stimulation for Camptocormia in Parkinson's Disease: A Systematic Review and Meta-Analysis.

机构信息

Department of Neurology, The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China.

出版信息

J Integr Neurosci. 2023 Jan 5;22(1):11. doi: 10.31083/j.jin2201011.

DOI:10.31083/j.jin2201011

PMID:36722246

Abstract

BACKGROUND

Camptocormia is one of the most common postural disorders of Parkinson's disease (PD) which has limited treatment options. In this review, we summarize the efficacy of deep brain stimulation (DBS) for camptocormia in PD.

METHODS

The PubMed (https://pubmed.ncbi.nlm.nih.gov/) and EMBASE databases (https://www.embase.com/) were searched for the terms "Parkinson Disease" and "camptocormia" in combination with "deep brain stimulation". We then explored the efficacy of DBS for camptocormia by statistical analysis of the bending angle, the Unified Parkinson's Disease Rating Scale III (UPDRS-III) and L-dopa equivalent daily dose (LEDD), and by evaluating the prognosis after DBS.

RESULTS

Twenty articles that reported results for 152 patients were included in this review. These comprised 136 patients from 16 studies who underwent subthalamic nucleus deep brain stimulation (STN-DBS), and 13 patients from 3 studies who underwent globus pallidus internus deep brain stimulation (GPi-DBS). One study used both STN-DBS (2 patients) and GPi-DBS (one patient). After 3-21 months of follow-up, the mean bending angle during the Off-period was significantly reduced compared to pre-DBS (31.5 ± 21.4 vs. 53.6 ± 22.7, respectively; < 0.0001). For the STN-DBS trials, the mean post-operative bending angles during both Off- and On-periods were significantly reduced compared to pre-operative (32.1 ± 22.7 vs. 55.4 ± 24.1, = 0.0003; and 33.1 ± 21.5 vs. 43.7 ± 20.6, = 0.0003, respectively). For GPi-DBS, the mean bending angle post-DBS during the Off-period was considerably lower than pre-DBS (28.5 ± 10.7 vs. 42.9 ± 9.9, < 0.001). The decrease in bending angle after DBS was negatively correlated with the duration of camptocormia (R = - 0.433, = 0.013), whereas positively associated with the pre-bending angle (R = 0.352, = 0.03).

CONCLUSIONS

DBS is an effective treatment for camptocormia in PD. Patients in the early stage of camptocormia with more significant bending angle may benefit more from DBS.

摘要

背景

脊柱前屈是帕金森病（PD）最常见的姿势障碍之一，其治疗选择有限。在本综述中，我们总结了深部脑刺激（DBS）治疗 PD 脊柱前屈的疗效。

方法

在 PubMed（https://pubmed.ncbi.nlm.nih.gov/）和 EMBASE 数据库（https://www.embase.com/）中搜索“帕金森病”和“脊柱前屈”与“深部脑刺激”相结合的术语。然后，我们通过统计弯曲角度、统一帕金森病评定量表 III（UPDRS-III）和左旋多巴等效日剂量（LEDD）分析 DBS 治疗脊柱前屈的疗效，并评估 DBS 后的预后。

结果

本综述共纳入了 20 篇报告了 152 例患者结果的文章。其中包括 16 项研究的 136 例接受丘脑底核深部脑刺激（STN-DBS）的患者，以及 3 项研究的 13 例接受苍白球内侧深部脑刺激（GPi-DBS）的患者。一项研究同时使用了 STN-DBS（2 例）和 GPi-DBS（1 例）。在 3-21 个月的随访中，与 DBS 前相比，关期平均弯曲角度显著降低（分别为 31.5±21.4°和 53.6±22.7°；<0.0001）。对于 STN-DBS 试验，与术前相比，术后关期和开期的平均术后弯曲角度均显著降低（分别为 32.1±22.7°和 55.4±24.1°，=0.0003；和 33.1±21.5°和 43.7±20.6°，=0.0003）。对于 GPi-DBS，DBS 后关期的平均弯曲角度明显低于 DBS 前（28.5±10.7°和 42.9±9.9°，<0.001）。DBS 后弯曲角度的降低与脊柱前屈的持续时间呈负相关（R=-0.433，=0.013），而与术前弯曲角度呈正相关（R=0.352，=0.03）。