Yousef Obai, Abouelmagd Moaz Elsayed, Abbas Abdallah, Elrosasy Amr, Shbani Abdulrahman, Raslan Ahmed M
Faculty of Medicine, Tartous University, Tartous, Syria.
Faculty of Medicine, Cairo University, Cairo, Egypt.
Neurosurg Rev. 2025 Jan 23;48(1):73. doi: 10.1007/s10143-025-03206-9.
Deep brain stimulation (DBS) is a valuable treatment for Parkinson's disease (PD), but postoperative delirium (POD) is a common complication. Understanding the risk factors for POD is crucial for optimizing patient selection and developing preventative measures. This systematic review and meta-analysis aims to identify predictors of POD in PD patients undergoing DBS surgery. We conducted a comprehensive search of four major databases for cohort studies on POD in patients undergoing DBS for PD, up to June 2024. Two reviewers independently screened studies, assessed the risk of bias using the Newcastle-Ottawa Scale, and extracted data. Meta-analysis was conducted using Review Manager, with heterogeneity assessed the I statistic and chi-square p value. Subgroup and sensitivity analyses were also performed to explore the consistency of findings. Eleven studies, including 1,368 patients, were analyzed to determine the incidence of POD in PD patients undergoing DBS. The incidence of POD in PD patients undergoing DBS, which was found to be 21% (95% CI: [14.6%, 27.4%]). Age, Mini-Mental State Examination (MMSE), and Non-Motor Symptom Scale (NMSS) were significant predictors, with effect sizes of (OR = 1.10, 95% CI: [1.06, 1.15], P < 0.00001), (OR = 0.85, 95% CI: [0.72, 1.00], P = 0.05), and (OR = 1.01, 95% CI: [1.00, 1.02], P = 0.04), respectively. However, gender, UPDRS-III ON score, brain atrophy, diabetes, Hamilton Anxiety Score (HAMA), operation time, disease duration, BMI, and cerebral infarction were not significant predictors. This meta-analysis suggests that age, cognitive function, and non-motor symptoms are important factors associated with POD patients undergoing DBS surgery. Further research with larger sample sizes and diverse populations is needed to confirm these findings and identify more specific predictors.
脑深部电刺激术（DBS）是治疗帕金森病（PD）的一种有效方法，但术后谵妄（POD）是一种常见并发症。了解POD的危险因素对于优化患者选择和制定预防措施至关重要。本系统评价和荟萃分析旨在确定接受DBS手术的PD患者发生POD的预测因素。我们对四个主要数据库进行了全面检索，以查找截至2024年6月接受PD-DBS治疗患者的POD队列研究。两名研究者独立筛选研究，使用纽卡斯尔-渥太华量表评估偏倚风险，并提取数据。使用Review Manager进行荟萃分析，用I统计量和卡方p值评估异质性。还进行了亚组分析和敏感性分析以探讨结果的一致性。对11项研究（包括1368例患者）进行分析，以确定接受DBS治疗的PD患者中POD的发生率。接受DBS治疗的PD患者中POD的发生率为21%（95%CI：[14.6%，27.4%]）。年龄、简易精神状态检查表（MMSE）和非运动症状量表（NMSS）是显著的预测因素，效应大小分别为（OR = 1.10，95%CI：[1.06，1.15]，P < 0.00001）、（OR = 0.85，95%CI：[0.72，1.00]，P = 0.05）和（OR = 1.01，95%CI：[1.00，1.02]，P = 0.04）。然而，性别、UPDRS-III开启状态评分、脑萎缩、糖尿病、汉密尔顿焦虑量表（HAMA）评分、手术时间、病程、体重指数（BMI）和脑梗死不是显著的预测因素。该荟萃分析表明，年龄、认知功能和非运动症状是与接受DBS手术的POD患者相关的重要因素。需要进行更大样本量和不同人群的进一步研究以证实这些发现并确定更具体的预测因素。
