改善帕金森病的运动功能和生活质量：深部脑刺激与聚焦超声手术的比较

Ameliorating motor performance and quality of life in Parkinson's disease: a comparison of deep brain stimulation and focused ultrasound surgery.

作者信息

Liang Mingqian, Hou Le, Liang Jinjun, Bao Shengyong

机构信息

Department of Rehabilitation Medicine, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.

Psychological Sleep Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Clinical Research Academy of Chinese Medicine), Guangzhou, Guangdong, China.

出版信息

Front Neurol. 2025 Apr 30;16:1449973. doi: 10.3389/fneur.2025.1449973. eCollection 2025.

INTRODUCTION

Deep brain stimulation (DBS) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) have emerged as valuable treatment options for Parkinson's disease (PD) with drug-resistant symptoms. However, comparative studies of various DBS targets and MRgFUS are still limited.

METHODS

We reviewed three databases for trials on the effects of DBS or MRgFUS on PD patients, focusing on motor performance and quality of life (QoL). A frequentist network meta-analysis was conducted to estimate the treatment effects.

RESULTS

There were 39 trials in this study, comprising 3,002 patients. In the off-phase, subthalamic nucleus_DBS (STN_DBS [SMD, -0.94; 95%CI, -1.40 to -0.48]) significantly improved the UPDRS-III Total score compared to medication treatment alone (MT). In the on-phase, STN_DBS (SMD, -0.83; 95%CI, -1.13 to -0.53), internal globus pallidus_DBS (GPi_DBS [SMD, -0.80; 95%CI, -1.20 to -0.40]), and STN_Focused Ultrasound (STN_FUS [SMD, -1.83; 95%CI, -2.97 to -0.68]) significantly improved the UPDRS-III Total score. Regarding QoL, STN_DBS (SMD, -0.75; 95% CI, -1.46 to -0.05) and GPi_DBS (SMD, -0.58; 95% CI, -0.96 to -0.21) demonstrated better outcomes compared to MT. The SUCRA plot indicated that the top three treatments for UPDRS-III Total score in the off-phase were STN_FUS (79.6%), STN-GPi_DBS (73.7%), and STN_DBS (69.1%). In the on-phase, the top three treatments were STN_FUS (95.7%), STN_DBS (69.6%), and GPi_DBS (66.9%). Regarding QoL, GPi_DBS (77.2%) ranks first, followed by STN_DBS (67.3%), STN_FUS (56.9%) ranks third.

CONCLUSION

STN_DBS, GPi_DBS, and STN_FUS have exhibited efficacy in ameliorating motor performance and enhancing QoL in PD patients. Nevertheless, as a potential alternative to STN_DBS with comparable efficacy, STN-FUS may serve as another treatment option.

引言

对于有耐药症状的帕金森病（PD）患者，脑深部电刺激术（DBS）和磁共振引导聚焦超声手术（MRgFUS）已成为有价值的治疗选择。然而，关于各种DBS靶点与MRgFUS的比较研究仍然有限。

方法

我们检索了三个数据库，以查找关于DBS或MRgFUS对PD患者影响的试验，重点关注运动表现和生活质量（QoL）。进行了频率学派网络荟萃分析以评估治疗效果。

结果

本研究中有39项试验，共3002例患者。在关期，与单纯药物治疗（MT）相比，丘脑底核DBS（STN_DBS [标准化均数差，-0.94；95%可信区间，-1.40至-0.48]）显著改善了统一帕金森病评定量表第三部分（UPDRS-III）总分。在开期，STN_DBS（标准化均数差，-0.83；95%可信区间，-1.13至-0.53）、苍白球内侧部DBS（GPi_DBS [标准化均数差，-0.80；95%可信区间，-1.20至-0.40]）和丘脑底核聚焦超声（STN_FUS [标准化均数差，-1.83；95%可信区间，-2.97至-0.68]）显著改善了UPDRS-III总分。关于生活质量，与MT相比，STN_DBS（标准化均数差，-0.75；95%可信区间，-1.46至-0.05）和GPi_DBS（标准化均数差，-0.58；95%可信区间，-0.96至-0.21）显示出更好的结果。累积排序曲线下面积（SUCRA）图表明，关期UPDRS-III总分的前三种最佳治疗方法是STN_FUS（79.6%）、STN-GPi_DBS（73.7%）和STN_DBS（69.1%）。在开期，前三种治疗方法是STN_FUS（95.7%）、STN_DBS（69.6%）和GPi_DBS（66.9%）。关于生活质量，GPi_DBS（77.2%）排名第一，其次是STN_DBS（67.3%），STN_FUS（56.9%）排名第三。