El Ghazal Nour, Nakanishi Hayato, Martinez-Nunez Alfonso E, Al Sabbakh Nader K, Segun-Omosehin Omotayo A, Bourdakos Natalie E, Nasser Maya, Matar Reem H, Than Christian, Danoun Omar A, Johnson Andrew
Neurosurgery, St George's University of London, London, GBR.
Neurosurgery, University of Nicosia Medical School, Nicosia, CYP.
Cureus. 2023 Aug 26;15(8):e44177. doi: 10.7759/cureus.44177. eCollection 2023 Aug.
Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the difference between subthalamic (STN) and globus pallidus internus (GPi) DBS on mood and quality of life with reference to minimal clinically important differences (MCID). A systematic literature search for articles published until November 2022 yielded 14 studies meeting the eligibility criteria, with a total of 1,088 patients undergoing STN (n=571) or GPi (n=517) stimulation. Baseline patient and clinical characteristics were comparable between the two groups. Results showed that GPi stimulation demonstrated a greater reduction in the Beck depression inventory (mean difference (MD)=1.68) than STN stimulation (MD=0.84). Hospital anxiety and depression scale showed a 2.69- and 3.48-point decrease by the GPi group in the depression and anxiety categories, respectively. The summary index (SI) of the PD questionnaire depicted a greater improvement in the GPi group from baseline (mean=41.01, 95% CI 34.89, 47.13) to follow-up (mean=30.85, 95% CI 22.08, 39.63) when compared to the STN group (baseline mean=42.43, 95% CI 34.50, 50.37; follow-up mean=34.21, 95% CI 25.43, 42.99). The emotions category also demonstrated a similar trend. However, STN stimulation showed greater reductions in motor symptoms and medication than GPi stimulation. This meta-analysis demonstrated that GPi stimulation seems to offer an advantage over STN stimulation in improving mood and quality of life in PD, but those effects must be further validated by larger studies.
深部脑刺激（DBS）被广泛用于治疗帕金森病（PD）的运动和非运动症状。本研究的目的是参照最小临床重要差异（MCID），调查丘脑底核（STN）和苍白球内侧部（GPi）深部脑刺激对情绪和生活质量的影响差异。对截至2022年11月发表的文章进行系统文献检索，得到14项符合纳入标准的研究，共有1088例患者接受了STN（n = 571）或GPi（n = 517）刺激。两组患者的基线特征和临床特征具有可比性。结果显示，与STN刺激（平均差值（MD）=0.84）相比，GPi刺激使贝克抑郁量表得分降低幅度更大（MD = 1.68）。医院焦虑抑郁量表显示，GPi组在抑郁和焦虑类别中分别下降了2.69分和3.48分。帕金森病问卷的汇总指数（SI）显示，与STN组（基线均值 = 42.43，95%可信区间34.50，50.37；随访均值 = 34.21，95%可信区间25.43，42.99）相比，GPi组从基线（均值 = 41.01，95%可信区间34.89，47.13）到随访（均值 = 30.85，95%可信区间22.08，39.63）有更大改善。情绪类别也呈现出类似趋势。然而，STN刺激在减少运动症状和药物使用方面比GPi刺激更显著。这项荟萃分析表明，在改善帕金森病患者的情绪和生活质量方面，GPi刺激似乎比STN刺激更具优势，但这些效果必须通过更大规模的研究进一步验证。
