帕金森病定向深部脑刺激电极：文献的荟萃分析与系统评价
Directional deep brain stimulation electrodes in Parkinson's disease: meta-analysis and systematic review of the literature.
作者信息
Hvingelby Victor, Khalil Fareha, Massey Flavia, Hoyningen Alexander, Xu San San, Candelario-McKeown Joseph, Akram Harith, Foltynie Thomas, Limousin Patricia, Zrinzo Ludvic, Krüger Marie T
机构信息
Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark.
Aarhus Universitetshospital, Aarhus, Denmark.
出版信息
J Neurol Neurosurg Psychiatry. 2025 Jan 16;96(2):188-198. doi: 10.1136/jnnp-2024-333947.
BACKGROUND
Since their introduction in 2015, directional leads have practically replaced conventional leads for deep brain stimulation (DBS) in Parkinson's disease (PD). Yet, the benefits of directional DBS (dDBS) over omnidirectional DBS (oDBS) remain unclear. This meta-analysis and systematic review compares the literature on dDBS and oDBS for PD.
METHODS
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Database searches included Pubmed, Cochrane (CENTRAL) and EmBase, using relevant keywords such as 'directional', 'segmented', 'brain stimulation' and 'neuromodulation'. The screening was based on the title and abstract.
RESULTS
23 papers reporting on 1273 participants (1542 leads) were included. The therapeutic window was 0.70 mA wider when using dDBS (95% CI 0.13 to 1.26 mA, p=0.02), with a lower therapeutic current (0.41 mA, 95% CI 0.27 to 0.54 mA, p=0.01) and a higher side-effect threshold (0.56 mA, 95% CI 0.38 to 0.73 mA, p<0.01). However, there was no relevant difference in mean Unified Parkinson's Disease Rating Scale III change after dDBS (45.8%, 95% CI 30.7% to 60.9%) compared with oDBS (39.0%, 95% CI 36.9% to 41.2%, p=0.39), in the medication-OFF state. Median follow-up time for dDBS and oDBS studies was 6 months and 3 months, respectively (range 3-12 for both). The use of directionality often improves dyskinesia, dysarthria, dysesthesia and pyramidal side effects. Directionality was used in 55% of directional leads at 3-6 months, remaining stable over time (56% at a mean of 14.1 months).
CONCLUSIONS
These findings suggest that stimulation parameters favour dDBS. However, these do not appear to have a significant impact on motor scores, and the availability of long-term data is limited. dDBS is widely accepted, but clinical data justifying its increased complexity and cost are currently sparse.
PROSPERO REGISTRATION NUMBER
CRD42023438056.
背景
自2015年定向电极被引入以来，在帕金森病（PD）的深部脑刺激（DBS）中，定向电极实际上已取代了传统电极。然而，定向DBS（dDBS）相对于全向DBS（oDBS）的优势仍不明确。本荟萃分析和系统评价比较了关于PD的dDBS和oDBS的文献。
方法
遵循系统评价和荟萃分析的首选报告项目指南。数据库检索包括PubMed、Cochrane（CENTRAL）和EmBase，使用“定向”“分段”“脑刺激”和“神经调节”等相关关键词。筛选基于标题和摘要。
结果
纳入了23篇报告1273名参与者（1542根电极）的论文。使用dDBS时治疗窗宽0.70 mA（95%CI 0.13至1.26 mA，p = 0.02），治疗电流较低（0.41 mA，95%CI 0.27至0.54 mA，p = 0.01），副作用阈值较高（0.56 mA，95%CI 0.38至0.73 mA，p<0.01）。然而，在药物未服用状态下，dDBS后帕金森病统一评分量表III平均变化（45.8%，95%CI 30.7%至60.9%）与oDBS（39.0%，95%CI 36.9%至41.2%，p = 0.39）相比无显著差异。dDBS和oDBS研究的中位随访时间分别为6个月和3个月（两者范围均为3 - 12个月）。使用方向性通常可改善运动障碍、构音障碍、感觉异常和锥体束副作用。在3 - 6个月时，55%的定向电极使用了方向性，且随时间保持稳定（平均14.1个月时为56%）。
结论
这些发现表明刺激参数有利于dDBS。然而，这些似乎对运动评分没有显著影响，且长期数据有限。dDBS已被广泛接受，但证明其增加的复杂性和成本合理的临床数据目前较少。
PROSPERO注册号：CRD42023438056。
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