Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson's disease: a systematic review and meta-analysis
Effect of high-frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson's disease: a systematic review and meta-analysis
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DOI：
10.1111/ene.13167
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发表时间：
2017-01-01
影响因子：
5.1
通讯作者：
Deuschl, G.
中科院分区：
文献类型：
--
作者：
Schlenstedt, C.;Shalash, A.;Deuschl, G.
本荟萃分析的目的是总结双侧丘脑底核脑深部电刺激（STN-DBS）对帕金森病步态和步态冻结（FOG）的短期和长期影响，并检测刺激后结局的预测因素。使用Medline奥维德数据库对截至2015年10月的文献进行了全面综述，以分析双侧STN-DBS对FOG和/或步态的影响。纳入了16项具有统一帕金森病评定量表（CAFRS）步态项（编号29）可用数据的研究和6项具有FOG项（编号14）的研究。总结了以下随访期的数据：6-15、24-48和>48个月。对于药物（Med）-关闭/刺激（Stim）-打开条件，与基线Med-Off相比，STN-DBS在6-15个月、24-48个月和>48个月时的平均步态分别从2.43分显著改善至0.96分、2.53分显著改善至1.31分和2.56分显著改善至1.40分（P < 0.05）。术前左旋多巴反应性的MERS-III和Med-Off严重程度的步态是预测这种有益的效果。与基线相比，在6-15个月、24-48个月和>48个月时，STN-DBS显著改善了Med-Off/Stim-On条件下的FOG，平均值分别为2.26至0.82、2.43至1.13和2.48至1.38分（P < 0.05）。在Med-On/StimOn条件下无显著影响。该荟萃分析显示，在Med-Off/Stim-On条件下，STN-DBS对步态和FOG的改善超过4年。未发现给药状态的有益影响。术前左旋多巴对整体运动表现的反应性（LMPRS-III）是脑深部电刺激对步态影响的最强预测因子。
The aim of this meta-analysis was to summarize the short-and long-term effects of bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) on gait and freezing of gait (FOG) in Parkinson's disease and to detect predictors of post-stimulation outcome. A comprehensive review of the literature was conducted up to October 2015 using Medline Ovid databases for studies analyzing the effect of bilateral STN-DBS on FOG and/or gait. Sixteen studies with available data for the gait item (no. 29) of the Unified Parkinson's Disease Rating Scale (UPDRS) and six studies with the FOG item (no. 14) were included. Data were summarized for the following follow-up periods: 6-15, 24-48 and >48 months. For the medication (Med)-Off/stimulation (Stim)-On condition compared with baseline Med-Off, STN-DBS significantly improved gait on average from 2.43 to 0.96, 2.53 to 1.31 and 2.56 to 1.40 points at 6-15, 24-48 and >48 months, respectively (P < 0.05). Pre-operative levodopa responsiveness of UPDRS-III and Med-Off severity of gait were the predictors of this beneficial effect. STN-DBS significantly improved FOG for the Med-Off/Stim-On condition compared with baseline on average from 2.26 to 0.82, 2.43 to 1.13 and 2.48 to 1.38 points at 6-15, 24-48 and >48 months, respectively (P < 0.05). There was no significant effect in the Med-On/StimOn condition. This meta-analysis showed a robust improvement of gait and FOG by STN-DBS for more than 4 years in the Med-Off/Stim-On condition. No beneficial effect was found for the On state of medication. Pre-operative levodopa responsiveness of global motor performance (UPDRS-III) is the strongest predictor of the effect of deep brain stimulation on gait.