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
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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：
''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.
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