Fangli Ning, Shi Lv, Wenxin Liu, Xinlei Zhang, Guohua Zhao, Wenjing Ning, Ziyuan Liu, Han Yan, Lei Qin, Hu Li, Yuzhen Xu
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引用次数: 0
Abstract
Background: Parkinson's disease (PD) is currently the second most common degenerative neurological disorder globally, with aspiration pneumonia caused by difficulty swallowing being the deadliest complication. The patient's subjective experience and the safety of swallowing have been the main focus of previous evaluations and treatment plans. The effectiveness of treatment may be attributed to the brain's ability to adapt and compensate. However, there is a need for more accurate assessment methods for dysphagia and further research on how treatment protocols work.
Objective: This systematic review was designed to assess the effectiveness and long-term impact of published treatment options for swallowing disorders in patients with PD.
Methods: In adherence to the Preferred Reporting Items for Reviews and Meta-analysis (PRISMA) guidelines, we conducted a systematic review where we thoroughly searched multiple databases (PubMed, Web of Science, Elsevier, and Wiley) for clinical studies published in various languages until December, 2023. Two reviewers evaluated the studies against strict inclusion/exclusion criteria.
Results: This systematic review included a total of 15 studies, including 523 participants, involving six treatment approaches, including breath training, deep brain stimulation, reduction of upper esophageal sphincter (UES) pressure, transcranial magnetic stimulation, postural compensation, and video-assisted swallowing therapy. Primary outcomes included video fluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), high-resolution pharyngeal impedance manometry (HPRIM), and functional magnetic resonance imaging (fMRI).
Conclusion: Treatments that reduce UES resistance may be an effective way to treat dysphagia in PD patients. HRPIM can quantify pressure changes during the pharyngeal period to identify patients with reduced swallowing function earlier. However, due to the limited number of randomized controlled trials (RCTs) included and the high risk of bias in some studies, large-scale RCTs are needed in the future, and objective indicators such as HRPIM should be used to determine the effectiveness and long-term impact of different therapies on dysphagia in PD patients.
背景：帕金森病（PD）目前是全球第二大最常见的退行性神经系统疾病，吞咽困难引起的吸入性肺炎是最致命的并发症。患者的主观体验和吞咽的安全性一直是以往评估和治疗计划的主要焦点。治疗的有效性可能归因于大脑的适应和补偿能力。然而，需要更准确的吞咽困难评估方法和进一步研究如何治疗方案的工作。目的：本系统综述旨在评估已发表的PD患者吞咽障碍治疗方案的有效性和长期影响。方法：根据优先报告项目的评价和荟萃分析（PRISMA）指南，我们进行了一次系统评价，我们彻底检索了多个数据库（PubMed, Web of Science， Elsevier和Wiley），以各种语言发表的临床研究，直到2023年12月。两名审稿人根据严格的纳入/排除标准对研究进行了评估。结果：本系统综述共纳入15项研究，包括523名参与者，涉及6种治疗方法，包括呼吸训练、深部脑刺激、降低食管上括约肌（UES）压力、经颅磁刺激、体位补偿和视频辅助吞咽治疗。主要结果包括视频透视吞咽研究（VFSS）、光纤内镜吞咽评估（FEES）、高分辨率咽阻抗测压（HPRIM）和功能磁共振成像（fMRI）。结论：减少UES抵抗可能是治疗PD患者吞咽困难的有效方法。HRPIM可以量化咽部期压力变化，早期识别吞咽功能减退的患者。然而，由于纳入的随机对照试验（RCTs）数量有限，且部分研究存在较高的偏倚风险，未来需要开展大规模的随机对照试验，并利用HRPIM等客观指标来确定不同治疗方法对PD患者吞咽困难的有效性和远期影响。
期刊介绍：
JIN is an international peer-reviewed, open access journal. JIN publishes leading-edge research at the interface of theoretical and experimental neuroscience, focusing across hierarchical levels of brain organization to better understand how diverse functions are integrated. We encourage submissions from scientists of all specialties that relate to brain functioning.
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