舞蹈病
脑深部刺激
评定量表
医学
亨廷顿病
不利影响
疾病
内科学
物理医学与康复
运动症状
物理疗法
心理学
帕金森病
发展心理学
作者
Zixiao Yin,Yutong Bai,Hua Zhang,Huanguang Liu,Wenjing Hu,Fangang Meng,Anchao Yang,Jianguo Zhang
标识
DOI:10.1016/j.brs.2020.09.025
摘要
ObjectiveThe efficacy of globus pallidus internus-deep brain stimulation (GPi-DBS) for the treatment of Huntington’s disease (HD) has not been validated in large-scale studies. We conducted an individual patient analysis to pool outcomes of all of the published HD-GPi-DBS studies.MethodsPubMed, Embase and the Cochrane Library were searched for relevant articles. The Unified Huntington’s Disease Rating Scale (UHDRS)-motor and UHDRS-chorea improvements were analyzed during different follow-up periods. Secondary outcomes, including UHDRS-motor subitem scores and functional assessment results, were also analyzed. Correlation and regression analyses were conducted to find improvement predictors. This study was registered in PROSPERO (CRD42018105995).ResultsEighteen studies including 39 patients with 124 visits were analyzed. GPi-DBS significantly improved the UHDRS-motor score in <3 months (p = 0.001), 3–9 months (p < 0.001), and 9–12 months (p < 0.001), but did not continue in later follow-ups. UHDRS-chorea was significantly improved even in the >30-month follow-up (p = 0.003). Functional assessment was not improved 12 months postoperatively (p = 0.196). The Westphal variant of HD (W-HD) gained no motor benefits 6 months postoperatively (p = 0.178). The Westphal variant was the only risk factor for DBS efficacy (p = 0.044). The rate of stimulation-related adverse events was 87.2%.ConclusionsGPi-DBS has a stable effect on chorea symptoms in HD patients. Chorea-dominant patients may be the best candidates for surgery, while attention should be paid to postoperative stimulation-related complications. Given that GPi-DBS has limited effects on other motor symptoms, W-HD patients are not surgical candidates.
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