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立体定向丘脑底核刺激术改善帕金森病患者社会适应的可能性:系统评价和荟萃分析。

Possible improvement of social adjustment after subthalamic deep brain stimulation in people with Parkinson's disease? A systematic review and meta-analysis.

机构信息

Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Victoria, Australia.

出版信息

J Neural Transm (Vienna). 2024 Oct;131(10):1187-1198. doi: 10.1007/s00702-024-02787-x. Epub 2024 May 25.

Abstract

Interactions with others need social adjustment (i.e., the constant accommodation to changing social situations). Mixed evidence indicates positive as well as negative changes in social adjustment after subthalamic nucleus deep brain stimulation (STN-DBS) in people with Parkinson's Disease (PwPD). To date, however, no meta-analysis of these changes exists. Thus, the study aim was to review evidence of the effects of STN-DBS on social adjustment in PwPD. For this purpose, a systematic literature search in MEDLINE was conducted. The meta-analysis was performed using a random effects model and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The MINORS tool was used to assess the methodological quality of the studies. The initial literature search identified 13,124 articles, of which 1,550 full texts were assessed for eligibility. Eight studies were finally included; for seven articles sufficient data for a meta-analysis was available. Most studies found mild impairment in social adjustment impairment pre-surgery. The meta-analysis revealed no significant changes but a statistical trend towards improvement in social adjustment up to six months (SMD = 0.25; 95%CI=-0.03,0.53; P = 0.08) and over 12 months (SMD = 0.26; 95%CI=-0.03,0.55; P = 0.07) post-surgery. Methodological quality was moderate in 87.5% of the studies and good in 12.5%. While mild impairment in social adjustment pre-surgery was reported in most studies, the data indicate that STN-DBS might yield beneficial effects toward this outcome. However, not enough data yet exists to draw firm conclusions. As a crucial skill for everyday functioning, social adjustment should be more often defined as an outcome in STN-DBS trials in PwPD and should be considered in clinical routines.

摘要

与他人的互动需要社会调节(即不断适应不断变化的社会情况)。混合证据表明,在帕金森病患者(PwPD)进行丘脑底核深部脑刺激(STN-DBS)后,社会调节会出现积极和消极的变化。然而,迄今为止,尚无关于这些变化的荟萃分析。因此,本研究旨在综述 STN-DBS 对 PwPD 社会调节影响的证据。为此,在 MEDLINE 中进行了系统的文献检索。使用随机效应模型和标准化均数差(SMD)及其 95%置信区间(CI)进行荟萃分析。使用 MINORS 工具评估研究的方法学质量。最初的文献检索确定了 13124 篇文章,其中有 1550 篇全文符合入选标准。最终纳入了 8 项研究;其中有 7 篇文章有足够的数据进行荟萃分析。大多数研究发现术前社会调节障碍有轻度损害。荟萃分析显示,术后 6 个月(SMD=0.25;95%CI=-0.03,0.53;P=0.08)和 12 个月以上(SMD=0.26;95%CI=-0.03,0.55;P=0.07)时,社会调节无显著变化,但有统计学趋势改善。87.5%的研究方法学质量为中度,12.5%为良好。尽管大多数研究报告术前社会调节障碍轻度受损,但数据表明 STN-DBS 可能对此结果产生有益影响。然而,目前还没有足够的数据得出明确的结论。作为日常生活的关键技能,社会调节应该在 PwPD 的 STN-DBS 试验中更频繁地被定义为结果,并在临床常规中被考虑。

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