Phân tích tổng hợp kết quả kích thích não sâu GPi và STN cho bệnh lý cổ gập

Deutsche Zeitschrift für Nervenheilkunde - Tập 267 - Trang 1278-1290 - 2020
Takashi Tsuboi1,2, Joshua K. Wong1, Leonardo Almeida1, Christopher W. Hess1, Aparna Wagle Shukla1, Kelly D. Foote3, Michael S. Okun1, Adolfo Ramirez-Zamora1
1Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, USA
2Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
3Department of Neurosurgery, University of Florida, Gainesville, USA

Tóm tắt

Để phân tích kết quả của phương pháp kích thích não sâu (DBS) ở bệnh nhân mắc chứng co thắt cổ (CD), mối quan hệ giữa các kết quả về vận động và tàn tật/đau đớn, cũng như sự khác biệt trong các kết quả giữa DBS tại nhân xám trong (GPi) và nhân dưới đồi (STN), và nhằm xác định các dự đoán kết quả tiềm năng. Một tìm kiếm tài liệu hệ thống đã xác định dữ liệu của từng bệnh nhân CD đã trải qua DBS và có kết quả được đánh giá bằng Thang điểm Cổ co thắt Toronto Western (TWSTRS). Sau đó, chúng tôi thực hiện một phân tích tổng hợp trên nhóm bệnh nhân này. Một cuộc khảo sát 39 bài báo đã cho kết quả 208 bệnh nhân với điểm số TWSTRS cá nhân và thông tin nhân khẩu học. Tại thời điểm theo dõi trung bình là 23,3 tháng sau DBS GPi hoặc STN, tổng TWSTRS (58,8%), độ nghiêm trọng (53,9%), tàn tật (61,3%) và điểm số đau (46,6%) đã được cải thiện đáng kể so với tình trạng ban đầu (tất cả p < 0,001). Không có sự khác biệt đáng kể về kết quả giữa ngắn hạn (< 23,3 tháng) và dài hạn (≥ 23,3 tháng). Kết quả TWSTRS sau DBS GPi và STN là tương tự nhau, trong khi hai mục tiêu này có các hồ sơ tác dụng phụ khác nhau. Tỷ lệ bệnh nhân phản ứng với DBS tính theo tổng TWSTRS và độ nghiêm trọng (được định nghĩa là ≥25% cải thiện) đều là 89%. Phân tích hồi quy cho thấy lợi ích vận động liên quan đến cải thiện tàn tật nhiều hơn là giảm đau (R2 = 0,345 và 0,195, tương ứng). Không có dự đoán lâm sàng có ý nghĩa nào được xác định cho các kết quả DBS. DBS cải thiện triệu chứng vận động, tàn tật và đau ở bệnh nhân CD và có thể mang lại lợi ích duy trì trong hơn 2 năm. GPi và STN dường như là những mục tiêu có hiệu quả tương đương với các hồ sơ tác dụng phụ khác nhau.

Từ khóa

#kích thích não sâu #bệnh lý cổ gập #GPi #STN #phân tích tổng hợp #TWSTRS

Tài liệu tham khảo

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