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首页> 外文期刊>Journal of neurology >Subthalamic deep brain stimulation and levodopa in Parkinson's disease: a meta-analysis of combined effects
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Subthalamic deep brain stimulation and levodopa in Parkinson's disease: a meta-analysis of combined effects

机译：帕金森病的亚饱和深脑刺激和左旋多巴：组合效应的荟萃分析

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IntroductionWhile subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa improve motor symptoms in Parkinson disease (PD) to a similar magnitude, their combined effect remains unclear. We sought to evaluate whether STN-DBS and levodopa yield differential effects on motor outcomes, dyskinesia, and activities of daily living (ADL) when combined compared to when administered alone.MethodsWe conducted a meta-analysis of all studies reporting motor, dyskinesia, and ADL outcomes after bilateral STN-DBS in PD with presurgical Unified Parkinson's Disease Rating Scale (UPDRS-III) in Medication-OFF and Medication-ON states and postsurgical assessments in four conditions: Stimulation-ON/Medication-ON, Stimulation-ON/Medication-OFF, Stimulation-OFF/Medication-ON, and Stimulation-OFF/Medication-OFF. Dyskinesia duration (UPDRS item 32) and ADL (UPDRS-II) were compared between high and low postsurgical levodopa equivalent daily dose (LEDD) reduction. Random-effects meta-analyses using generic-inverse variance were conducted. Confidence in outcomes effect sizes was assessed.ResultsTwelve studies were included (n=401 patients). Stimulation-ON/Medication-ON was associated with an UPDRS-III improvement of -35.7 points [95% confidence interval, -40.4, -31.0] compared with Stimulation-OFF/Medication-OFF, -11.2 points [-14.0, -8.4] compared with Stimulation-OFF/Medication-ON, and -9.5 points [-11.0, -8.0] compared to Stimulation-ON/Medication-OFF within 5years. The difference was maintained beyond 5years by -28.6 [-32.8, -24.4], -8.1 [-10.2, -5.9], and -8.0 [-10.3, -5.6], respectively. No difference was observed between Stimulation-ON/Medication-OFF and Stimulation-OFF/Medication-ON within and beyond 5years. Dyskinesia duration and ADL outcomes were similar in high vs. low postsurgical LEDD reduction.ConclusionSubthalamic nucleus deep brain stimulation and levodopa independently lessened motor severity in PD to a similar magnitude, but their combined effect was greater than either treatment alone, suggesting therapeutic synergism.
机译：引入亚饱和核细胞核深脑刺激（STN-DBS）和左旋多巴改善了帕金森病（PD）的电机症状（PD）到类似的幅度，它们的组合效果仍然尚不清楚。当单独给药时，我们试图评估STN-DBS和左旋多巴是否对每日生活（ADL）的运动结果，吞吐量和日常生活（ADL）的活动。一致的所有研究报告电机，疑难智和双侧STN-DBS的ADL成果在PD中具有预先统一帕金森病评级规模（UPDRS-III）的药物和药物治疗状态，在四种条件下和后期评估：刺激/药物 - 上，刺激/药物-off，刺激/药物 - 接受，刺激/药物。在高低和低后面的左体左流Devodopa等效每日剂量（LEDD）减少之间比较了止咳瘤持续时间（UPDRS第32项）和ADL（UPDRS-II）。进行了使用通用逆差的随机效应元分析。评估对结果的置信效应大小。包括患者研究（n = 401名患者）。刺激/药物 - on与updrs-III改善相关-35.7点[95％置信区间，-40.4，-31.0]与刺激/药物截止相比，-11.2点[-14.0，-8.4 [与5年内，与刺激/药物接通和-9.5分[-11.0，-8.0]相比，与刺激/药物脱落。在-28.6 [-32.8，-24.4]，-8.1 [-10.2，-5.9]和-8.0 [-10.3，-5.6]中，差异超出5年。在5年内和超过5年内刺激/药物脱落和刺激/药物的刺激/药物脱落和药物之间没有差异。止咳瘤的持续时间和ADL结果在高比较低的后期液体氧化物中.Conlusionsubthalamic核心深脑刺激和Levodopa在Pd中独立地减少了PD的运动严重程度，但它们的组合效果大于单独治疗，表明治疗协同作用。

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