Mohamed F Abo-Elsoad, Ahmed W Abbas, Amr M Abou Elezz, Mohamed Abo Zaid, Alaa N Ahmed, Omar Hewezy, Ahmed Talkhan
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However, evidence for TNS in PD patients remains limited and varied.</p><p><strong>Purpose: </strong>To evaluate the efficacy of TNS (percutaneous and transcutaneous) for LUTS in patients with PD, focusing on both subjective symptom outcomes and objective urodynamic parameters through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic search identified relevant randomized controlled trials (RCTs) and prospective single-arm studies on PTNS efficacy. Data were analyzed using RevMan Cochrane software (v5.4) and R (v4.3.2), with results pooled as mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals. Meta-regression assessed the influence of PD duration.</p><p><strong>Results: </strong>Seven studies (three RCTs and four prospective cohorts) were included in this review, with a total of 591 participants. 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引用次数: 0
摘要
背景：下尿路症状（LUTS）是帕金森病（PD）的一个常见和繁重的部分。传统的治疗方法并不总是有效，因此像胫神经刺激（TNS）这样的微创治疗方法很有希望。然而，PD患者中TNS的证据仍然有限且多样。目的：通过系统回顾和荟萃分析，评价TNS（经皮和经皮）治疗PD患者LUTS的疗效，重点关注主观症状结局和客观尿动力学参数。方法：系统检索了相关的随机对照试验（rct）和前瞻性单臂研究PTNS疗效。采用RevMan Cochrane软件（v5.4）和R软件（v4.3.2）对数据进行分析，将结果汇总为平均差（MD）或标准化平均差（SMD）和95%置信区间。meta回归评估PD持续时间的影响。结果：本综述纳入了7项研究（3项随机对照试验和4项前瞻性队列），共591名受试者。TNS改善了尿动力学结果，包括首次非自愿逼尿肌收缩量（+ 107.49 mL, 95% CI 99.43至115.56），最大膀胱容量（+ 90 mL, 95% CI 83.14至96.84）和逼尿肌压力（Pdetmax和PdetQmax降低）。相比之下，合并的证据对于患者报告的结局，包括急症、尿频、尿失禁和夜尿，仍然是不一致的。meta回归分析显示PD持续时间与治疗反应无显著相关性。结论：TNS改善了PD患者的尿动力学功能，但这种客观上的改善并不能一致地转化为主观症状的缓解，这突出了PD相关LUTS的复杂性。未来的采用需要更大规模、标准化的随机对照试验，并延长随访时间，以确定哪些患者受益最大。
Non-invasive neuromodulation for LUTS in Parkinson's disease: a comprehensive systematic review and meta-analysis of tibial nerve stimulation with GRADE evaluation.
Background: Lower urinary tract symptoms (LUTS) are a common and burdensome part of Parkinson's disease (PD). Conventional treatments are inconsistently effective, making minimally invasive options like tibial nerve stimulation (TNS) promising. However, evidence for TNS in PD patients remains limited and varied.
Purpose: To evaluate the efficacy of TNS (percutaneous and transcutaneous) for LUTS in patients with PD, focusing on both subjective symptom outcomes and objective urodynamic parameters through a systematic review and meta-analysis.
Methods: A systematic search identified relevant randomized controlled trials (RCTs) and prospective single-arm studies on PTNS efficacy. Data were analyzed using RevMan Cochrane software (v5.4) and R (v4.3.2), with results pooled as mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals. Meta-regression assessed the influence of PD duration.
Results: Seven studies (three RCTs and four prospective cohorts) were included in this review, with a total of 591 participants. TNS improved urodynamic outcomes, including first involuntary detrusor contraction volume (+ 107.49 mL, 95% CI 99.43 to 115.56), maximum cystometric capacity (+ 90 mL, 95% CI 83.14 to 96.84), and detrusor pressures (Pdetmax and PdetQmax reductions). In contrast, pooled evidence remained heterogeneous and inconsistent for patient-reported outcomes, including urgency, frequency, incontinence, and nocturia. Meta-regression analysis revealed no significant association between PD duration and treatment response.
Conclusions: TNS improved urodynamic function in PD patients, but this objective improvement does not consistently translate to subjective symptom relief, highlighting the complexity of PD-related LUTS. Future adoption requires larger, standardized RCTs with extended follow-up to identify which patients benefit most.
期刊介绍：
Peer-reviewed and published quarterly, Acta Neurologica Belgicapresents original articles in the clinical and basic neurosciences, and also reports the proceedings and the abstracts of the scientific meetings of the different partner societies. The contents include commentaries, editorials, review articles, case reports, neuro-images of interest, book reviews and letters to the editor.
Acta Neurologica Belgica is the official journal of the following national societies:
Belgian Neurological Society
Belgian Society for Neuroscience
Belgian Society of Clinical Neurophysiology
Belgian Pediatric Neurology Society
Belgian Study Group of Multiple Sclerosis
Belgian Stroke Council
Belgian Headache Society
Belgian Study Group of Neuropathology
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