Huhn Makenna, Prewett Matthew, Rossignol Julien, Dunbar Gary L
Program in Neuroscience, Central Michigan University, Mount Pleasant 48859, Michigan, USA.
College of Medicine, Central Michigan University, Mount Pleasant 48859, Michigan, USA.
Parkinsons Dis. 2024 Nov 26;2024:5157873. doi: 10.1155/padi/5157873. eCollection 2024.
A cardinal symptom of Parkinson's disease (PD) is motor dysfunction, including bradykinesia and tremors, which is quantified in the Unified PD Rating Scale (UPDRS). Although some medications provide palliative treatments for these motor deficits, their efficacy wanes and can produce unwanted side effects, such as dyskinesia. Deep-brain stimulation (DBS) has provided an alternative treatment strategy that can benefit many patients, but optimal target structures for DBS and its long-term efficacy are not fully understood. The present study represents a meta-analysis of the long-term (> 5 years) effects of DBS on the two most common targets, the subthalamic nucleus (STN) and the globus pallidus interna (GPi), on scores of motor performance using the UPDRS-III. The initial search of PubMed, Cochrane Library, and Clinical Trials resulted in 197 articles, of which 28 met the criteria for our analysis. Of the 1321 patients included, 1179 received STN DBS group and 142 received GPi DBS. UPDRS-III scores for both target groups were analyzed at baseline and at either 5-8 or 10-15 years later for both on- and off-medication phases. The results indicated that the STN stimulation is effective at reducing motor symptoms during off-medication treatment for up to 15 years and that the GPi stimulation can be effective for up to at least 8 years. Our findings further suggest that STN- and GPi-targeted DBS may wear off during the on-medication phase between 5 and 10 years of treatment. This study supports findings that both DBSs of either the STN or GPi have long-term efficacy, especially during off-medication periods.
帕金森病（PD）的一个主要症状是运动功能障碍，包括运动迟缓及震颤，这些症状通过统一帕金森病评定量表（UPDRS）进行量化。尽管一些药物可为这些运动缺陷提供姑息治疗，但其疗效会逐渐减弱并可能产生如运动障碍等不良副作用。深部脑刺激（DBS）提供了一种可使许多患者受益的替代治疗策略，但DBS的最佳靶点结构及其长期疗效尚未完全明确。本研究是一项荟萃分析，探讨了DBS对两个最常见靶点——丘脑底核（STN）和内侧苍白球（GPi）——使用UPDRS-III运动表现评分的长期（>5年）影响。最初在PubMed、Cochrane图书馆和临床试验数据库进行检索后得到197篇文章，其中28篇符合我们的分析标准。在纳入的1321例患者中，1179例接受了STN-DBS治疗，142例接受了GPi-DBS治疗。对两个靶点组的UPDRS-III评分在基线时以及在5 - 8年或10 - 15年后的服药期和非服药期进行分析。结果表明，STN刺激在非服药治疗期间长达15年对减轻运动症状有效，而GPi刺激至少在长达8年时有效。我们的研究结果进一步表明，在治疗5至10年的服药期内，针对STN和GPi的DBS效果可能会减弱。本研究支持了以下发现：针对STN或GPi的DBS均具有长期疗效，尤其是在非服药期。
