Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Parana, Rua General Carneiro, 181, Curitiba, 80060-900, PR, Brazil.
Neurosurgery Department, Faculdade Pequeno Principe, Av Iguaçu, 333, Curitiba, Brazil.
Neurosurg Rev. 2024 Sep 3;47(1):525. doi: 10.1007/s10143-024-02761-x.
Patients with advanced Parkinson's disease often suffer from severe gait and balance problems, impacting quality of live and persisting despite optimization of standard therapies. The aim of this review was to systematically review the efficacy of STN-DBS programming techniques in alleviating gait disturbances in patients with advanced PD. Searches were conducted in PubMed, Embase, and Lilacs databases, covering studies published until May 2024. The review identified 36 articles that explored five distinct STN-DBS techniques aimed at addressing gait and postural instability in Parkinson's patients: low-frequency stimulation, ventral STN stimulation for simultaneous substantia nigra activation, interleaving, asymmetric stimulation and a short pulse width study. Among these, 21 articles were included in the meta-analysis, which revealed significant heterogeneity among studies. Notably, low-frequency STN-DBS demonstrated positive outcomes in total UPDRS-III score and FOG-Q, especially when combined with dopaminergic therapy. The most favorable results were found for low-frequency STN stimulation. The descriptive analysis suggests that unconventional stimulation approaches may be viable for gait problems in patients who do not respond to standard therapies.
患有晚期帕金森病的患者常常遭受严重的步态和平衡问题的困扰，尽管标准疗法已经得到优化，但这些问题仍然存在并影响生活质量。本综述的目的是系统地回顾 STN-DBS 编程技术在缓解晚期 PD 患者步态障碍方面的疗效。在 PubMed、Embase 和 Lilacs 数据库中进行了检索，涵盖了截至 2024 年 5 月发表的研究。该综述共确定了 36 篇文章，探讨了五种不同的 STN-DBS 技术，旨在解决帕金森病患者的步态和姿势不稳定问题：低频刺激、同时刺激腹侧 STN 以激活黑质、交错刺激、不对称刺激和短脉冲宽度研究。其中，21 篇文章被纳入荟萃分析，研究之间存在显著的异质性。值得注意的是，低频 STN-DBS 在 UPDRS-III 总分和 FOG-Q 方面显示出积极的结果，尤其是与多巴胺能治疗联合使用时。低频 STN 刺激的结果最为有利。描述性分析表明，对于对标准疗法无反应的患者，非常规刺激方法可能是解决步态问题的可行选择。
