Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada,
Krembil Research Institute, University Health Network, Toronto, Ontario, Canada,
Stereotact Funct Neurosurg. 2023;101(4):244-253. doi: 10.1159/000531089. Epub 2023 Jul 10.
Spinal cord stimulation (SCS) has been investigated as a potential therapeutic option for managing refractory symptoms in patients with Parkinson's disease (PD).
This systematic review and meta-analysis aimed to evaluate the safety and efficacy of SCS in PD.
A comprehensive literature search was conducted on PubMed and Web of Science to identify SCS studies reporting Unified Parkinson Disease Rating Scale-III (UPDRS-III) or Visual Analogue Scale (VAS) score changes in PD cohorts with at least 3 patients and a follow-up period of at least 1 month. Treatment effect was measured as the mean change in outcome scores and analyzed using an inverse variance random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale and funnel plots.
A total of 11 studies comprising 76 patients were included. Nine studies involving 72 patients reported an estimated decrease of 4.43 points (95% confidence interval [CI]: 2.11; 6.75, p < 0.01) in UPDRS-III score, equivalent to a 14% reduction. The axial subscores in 48 patients decreased by 2.35 points (95% CI: 1.26; 3.45, p < 0.01, 20% reduction). The pooled effect size of five studies on back and leg pain VAS scores was calculated as 4.38 (95% CI: 2.67; 6.09, p < 0.001), equivalent to a 59% reduction.
Our analysis suggests that SCS may provide significant motor and pain benefits for patients with PD, although the results should be interpreted with caution due to several potential limitations including study heterogeneity, open-label designs, small sample sizes, and the possibility of publication bias. Further research using larger sample sizes and placebo-/sham-controlled designs is needed to confirm effectiveness.
脊髓刺激（SCS）已被研究作为一种潜在的治疗选择，以管理帕金森病（PD）患者的难治性症状。
本系统评价和荟萃分析旨在评估 SCS 在 PD 中的安全性和疗效。
我们在 PubMed 和 Web of Science 上进行了全面的文献检索，以确定 SCS 研究报告了至少 3 名患者和至少 1 个月随访期的 PD 队列中 UPDRS-III 或视觉模拟量表（VAS）评分变化。使用逆方差随机效应模型分析治疗效果作为结局评分的平均变化。使用纽卡斯尔-渥太华量表和漏斗图评估偏倚风险。
共纳入 11 项研究，共 76 例患者。9 项涉及 72 例患者的研究报告了 UPDRS-III 评分估计下降 4.43 分（95%可信区间：2.11；6.75，p < 0.01），相当于 14%的降幅。48 例患者的轴性亚评分下降 2.35 分（95%可信区间：1.26；3.45，p < 0.01，20%降幅）。5 项关于背部和腿部疼痛 VAS 评分的研究的汇总效应大小为 4.38（95%可信区间：2.67；6.09，p < 0.001），相当于 59%的降幅。
我们的分析表明，SCS 可能为 PD 患者提供显著的运动和疼痛益处，但由于研究异质性、开放标签设计、样本量小以及可能存在发表偏倚等多种潜在局限性，结果应谨慎解释。需要进一步使用更大样本量和安慰剂/假手术对照设计的研究来证实其有效性。
