Can Sarica, Ajmal Zemmar, Omid Yousefi, Andrew C Yang, Ayse Uzuner, Zhiyuan Sheng, Brendan Santyr, Nardin Samuel, Michael Colditz, Artur Vetkas, Jürgen Germann, Cletus Cheyuo, Mohammadmahdi Sabahi, Raja Niranjan Jani, Ghazaleh Darmani, Kazuaki Yamamoto, David H Aguirre-Padilla, Joseph S Neimat, Suneil K Kalia, Robert Chen, Alfonso A Fasano, Andres M Lozano
{"title":"Spinal Cord Stimulation for Parkinson's Disease: A Systematic Review and Meta-Analysis of Pain and Motor Outcomes.","authors":"Can Sarica, Ajmal Zemmar, Omid Yousefi, Andrew C Yang, Ayse Uzuner, Zhiyuan Sheng, Brendan Santyr, Nardin Samuel, Michael Colditz, Artur Vetkas, Jürgen Germann, Cletus Cheyuo, Mohammadmahdi Sabahi, Raja Niranjan Jani, Ghazaleh Darmani, Kazuaki Yamamoto, David H Aguirre-Padilla, Joseph S Neimat, Suneil K Kalia, Robert Chen, Alfonso A Fasano, Andres M Lozano","doi":"10.1159/000531089","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) has been investigated as a potential therapeutic option for managing refractory symptoms in patients with Parkinson's disease (PD).</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the safety and efficacy of SCS in PD.</p><p><strong>Method: </strong>A comprehensive literature search was conducted on PubMed and Web of Science to identify SCS studies reporting Unified Parkinson Disease Rating Scale-III (UPDRS-III) or Visual Analogue Scale (VAS) score changes in PD cohorts with at least 3 patients and a follow-up period of at least 1 month. Treatment effect was measured as the mean change in outcome scores and analyzed using an inverse variance random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale and funnel plots.</p><p><strong>Results: </strong>A total of 11 studies comprising 76 patients were included. Nine studies involving 72 patients reported an estimated decrease of 4.43 points (95% confidence interval [CI]: 2.11; 6.75, p < 0.01) in UPDRS-III score, equivalent to a 14% reduction. The axial subscores in 48 patients decreased by 2.35 points (95% CI: 1.26; 3.45, p < 0.01, 20% reduction). The pooled effect size of five studies on back and leg pain VAS scores was calculated as 4.38 (95% CI: 2.67; 6.09, p < 0.001), equivalent to a 59% reduction.</p><p><strong>Conclusions: </strong>Our analysis suggests that SCS may provide significant motor and pain benefits for patients with PD, although the results should be interpreted with caution due to several potential limitations including study heterogeneity, open-label designs, small sample sizes, and the possibility of publication bias. Further research using larger sample sizes and placebo-/sham-controlled designs is needed to confirm effectiveness.</p>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10614495/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000531089","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/10 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Spinal cord stimulation (SCS) has been investigated as a potential therapeutic option for managing refractory symptoms in patients with Parkinson's disease (PD).
Objective: This systematic review and meta-analysis aimed to evaluate the safety and efficacy of SCS in PD.
Method: A comprehensive literature search was conducted on PubMed and Web of Science to identify SCS studies reporting Unified Parkinson Disease Rating Scale-III (UPDRS-III) or Visual Analogue Scale (VAS) score changes in PD cohorts with at least 3 patients and a follow-up period of at least 1 month. Treatment effect was measured as the mean change in outcome scores and analyzed using an inverse variance random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale and funnel plots.
Results: A total of 11 studies comprising 76 patients were included. Nine studies involving 72 patients reported an estimated decrease of 4.43 points (95% confidence interval [CI]: 2.11; 6.75, p < 0.01) in UPDRS-III score, equivalent to a 14% reduction. The axial subscores in 48 patients decreased by 2.35 points (95% CI: 1.26; 3.45, p < 0.01, 20% reduction). The pooled effect size of five studies on back and leg pain VAS scores was calculated as 4.38 (95% CI: 2.67; 6.09, p < 0.001), equivalent to a 59% reduction.
Conclusions: Our analysis suggests that SCS may provide significant motor and pain benefits for patients with PD, although the results should be interpreted with caution due to several potential limitations including study heterogeneity, open-label designs, small sample sizes, and the possibility of publication bias. Further research using larger sample sizes and placebo-/sham-controlled designs is needed to confirm effectiveness.
背景：脊髓刺激（SCS）已被研究为治疗帕金森病（PD）患者难治性症状的潜在治疗选择。目的：本系统综述和荟萃分析旨在评估脊髓刺激系统治疗帕金森病的安全性和有效性。方法：在PubMed和Web of Science上进行全面的文献检索，以确定报告帕金森病统一评定量表III（UPDRS-III）或视觉模拟量表（VAS）评分变化的脊髓刺激系统研究，这些研究涉及至少3名患者，随访期至少为1个月。治疗效果被测量为结果得分的平均变化，并使用逆方差随机效应模型进行分析。使用纽卡斯尔-渥太华量表和漏斗图评估偏倚风险。结果：共纳入11项研究，包括76名患者。涉及72名患者的9项研究报告称，UPDRS-III评分估计降低了4.43分（95%置信区间[CI]:2.11；6.75，p<；0.01），相当于降低了14%。48例患者的轴向分量表下降了2.35分（95%可信区间：1.26；3.45，p＜0.01，下降20%）。五项背部和腿部疼痛VAS评分研究的合并效应大小计算为4.38（95%CI:2.67；6.09，p<；0.001），相当于减少了59%。结论：我们的分析表明，SCS可能为帕金森病患者提供显著的运动和疼痛益处，尽管由于研究异质性、开放标签设计、小样本量和发表偏倚的可能性等潜在局限性，应谨慎解释结果。需要使用更大样本量和安慰剂/假手术对照设计进行进一步研究，以确认有效性。
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
