University of Minnesota Twin Cities Medical School, Minneapolis, Minnesota, USA.
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Stereotact Funct Neurosurg. 2023;101(3):170-178. doi: 10.1159/000529418. Epub 2023 Mar 10.
Essential tremor (ET) patients present with both motor and non-motor symptoms including depression. Although deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) is used to treat motor symptoms of ET, there is no consensus as to how VIM DBS influences non-motor symptoms, specifically depression.
The objective of this study was to conduct a meta-analysis of available studies investigating change in pre- to postoperative depression scores as measured by Beck Depression Inventory (BDI) in ET patients receiving VIM DBS.
Inclusion criteria were randomized control trials or observational studies of patients undergoing unilateral/bilateral VIM DBS. Non-ET patients, case reports, patients <18 years old, only non-VIM electrode placement, non-English articles, and abstracts were excluded. The primary outcome was change in BDI score from the preoperative time point to the last available follow-up. Pooled estimates of overall effect for BDI standardized mean difference were calculated using random effects models with the inverse variance method.
Seven studies divided into eight cohorts for a total of 281 ET patients met inclusion criteria. Pooled preoperative BDI score was 12.44 (95% CI [6.63-18.25]). A statistically significant decrease in depression scores was observed postoperatively (SMD = -0.29, 95% CI [-0.46 to -0.13], p = 0.0006). Pooled postoperative BDI score was 9.18 (95% CI [4.98-13.38]). A supplementary analysis which included an additional study with an estimated standard deviation at last follow-up was conducted. There was also a statistically significant decrease in depression postoperatively (9 cohorts, n = 352, SMD = -0.31, 95% CI [-0.46 to -0.16], p < 0.0001).
Both quantitative and qualitative analyses of the existing literature suggest that VIM DBS improves depression postoperatively among ET patients. These results may guide surgical risk-benefit analysis and counseling for ET patients undergoing VIM DBS.
特发性震颤（ET）患者既有运动症状又有非运动症状，包括抑郁。虽然腹侧中间核（VIM）深部脑刺激（DBS）用于治疗 ET 的运动症状，但对于 VIM DBS 如何影响非运动症状，特别是抑郁，尚无共识。
本研究的目的是对现有的研究进行荟萃分析，这些研究调查了接受 VIM DBS 的 ET 患者，通过贝克抑郁量表（BDI）测量，术前至术后抑郁评分的变化。
纳入标准为接受单侧/双侧 VIM DBS 的随机对照试验或观察性研究。排除非 ET 患者、病例报告、年龄<18 岁、仅非 VIM 电极放置、非英文文章和摘要。主要结果是 BDI 评分从术前时间点到最后一次可获得的随访时间点的变化。使用随机效应模型和逆方差法计算 BDI 标准化均数差值的总体效应的合并估计值。
7 项研究分为 8 个队列，共有 281 名 ET 患者符合纳入标准。合并的术前 BDI 评分 12.44（95%CI [6.63-18.25]）。术后观察到抑郁评分显著下降（SMD=-0.29，95%CI[-0.46 至-0.13]，p=0.0006）。合并的术后 BDI 评分 9.18（95%CI [4.98-13.38]）。进行了一项补充分析，其中包括一项最后随访时估计标准差的额外研究。术后抑郁也有统计学意义下降（9 个队列，n=352，SMD=-0.31，95%CI[-0.46 至-0.16]，p<0.0001）。
对现有文献的定量和定性分析均表明，VIM DBS 可改善 ET 患者术后的抑郁。这些结果可能为接受 VIM DBS 的 ET 患者的手术风险-效益分析和咨询提供指导。
