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在帕金森病中使用基于设备的先进治疗方法的跌倒风险:系统性审查和网络元分析

Rajasumi Rajalingam¹, Gianluca Sorrento¹, Alfonso Fasano^2,3,4

¹Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.

Journal of neurology, neurosurgery, and psychiatry

|November 21, 2024

概括

对帕金森病 (PD) 的深度大脑刺激 (DBS) 可能会增加跌倒的风险,特别是针对下丘脑核 (STN). 持续的皮下输注 (fos) 莱沃多巴 (CSCI) 显示在PD患者的跌倒预防方面有前途.

科学领域:

神经学神经学
神经外科神经外科
运动障碍运动障碍

背景情况:

帕金森病 (PD) 的运动并发症可以通过深度大脑刺激 (DBS) 和输液疗法来治疗.
这些先进疗法在预防PD患者跌倒方面的作用不太清楚.

研究的目的:

系统地审查和执行一个网络元分析 (NMA),评估与帕金森病先进疗法相关的跌倒风险.

主要方法:

在多个数据库 (PubMed,Medline,Embase,CINAHL) 进行系统搜索,直到2024年3月,遵守PRISMA-NMA指南.
根据PICOS框架的DBS (STN或GPi) 和输液疗法与最佳医疗 (BMT) 或假刺激的资格标准.
使用RevMan V.5.4和R软件 (netmeta包) 进行的双对元分析和NMA.

主要成果:

这项分析包括了14项研究.
与BMT相比,深度大脑刺激 (DBS) 显示了增加跌倒的趋势;灵敏度分析显示,跌倒风险明显更高 (RR=2.74).
利沃多巴-卡比多巴肠凝 (LCIG) 显示出增加跌倒风险的趋势,而持续的皮下输注 (fos) 利沃多巴 (CSCI) 显著降低了跌倒风险. 美国国家药物管理局表示,CSCI在降落减少方面最有效,STN DBS与最高风险相关.

结论:

深度大脑刺激 (DBS),特别是针对下丘脑核 (STN),与非DBS高级程序相比,可能会增加帕金森病患者的跌倒风险.
虽然LCIG可能不会显著改变跌倒风险,但初步证据表明,CSCI对PD的跌倒预防有积极的影响.

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