Xing Hua1,2, Bohan Zhang1,2, Zhicheng Zheng3, Houyou Fan1,2, Linfeng Luo1,2, Xiaosi Chen1,2, Jian Duan1, Dongwei Zhou1, Meihua Li1, Tao Hong1, Guohui Lu4. 1. Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. 2. The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China. 3. The Fourth Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China. 4. Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. guohui-lu@163.com.
Abstract
BACKGROUND: Deep brain stimulation (DBS) therapy has been suggested to be a beneficial alternative in cervical dystonia (CD) for patients who failed nonsurgical treatments. This individual patient data meta-analysis compared the efficacy of DBS in the globus pallidus internus (GPi) versus subthalamic nucleus (STN) and identified possible predictive factors for CD. METHODS: Three electronic databases (PubMed, Embase and Web of Science) were searched for studies with no publication date restrictions. The primary outcomes were normalized by calculating the relative change in TWSTRS total scores and subscale scores at the last follow-up. Data were analyzed mainly using Pearson's correlation coefficients and a stepwise multivariate regression analysis. RESULTS: Thirteen studies (86 patients, 58 with GPi-DBS and 28 with STN-DBS) were eligible. Patients showed significant improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) (52.5 ± 11.6 vs 21.9 ± 14.9, P < 0.001) scores at the last follow-up (22.0 ± 14.3 months), compared with scores at baseline, with a mean improvement of 56.6% (P < 0.001) (54.9% in severity, 63.2% in disability, 41.7% in pain). There was no significant difference in the improvement (%) of the total TWSTRS scores in 3 years for the GPI and STN groups (58.1 ± 22.6 vs 47.5 ± 39.2, P > 0.05). Age at surgery and age at symptom onset were negatively correlated with the relative changes in TWSTRS scores at the last follow-up, while there was a positive correlation with preoperative TWSTRS scores. On the stepwise multivariate regression, only the age at surgery remained significant in the best predictive model. CONCLUSIONS: GPi-DBS and STN-DBS both provided a common great improvement in the symptoms of CD patients in 3 years. Earlier age at surgery may probably indicate larger improvement. More randomized large-scale clinical trials are warranted in the future.
BACKGROUND: Deep brain stimulation (DBS) therapy has been suggested to be a beneficial alternative in cervical dystonia (CD) for patients who failed nonsurgical treatments. This individual patient data meta-analysis compared the efficacy of DBS in the globus pallidus internus (GPi) versus subthalamic nucleus (STN) and identified possible predictive factors for CD. METHODS: Three electronic databases (PubMed, Embase and Web of Science) were searched for studies with no publication date restrictions. The primary outcomes were normalized by calculating the relative change in TWSTRS total scores and subscale scores at the last follow-up. Data were analyzed mainly using Pearson's correlation coefficients and a stepwise multivariate regression analysis. RESULTS: Thirteen studies (86 patients, 58 with GPi-DBS and 28 with STN-DBS) were eligible. Patients showed significant improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) (52.5 ± 11.6 vs 21.9 ± 14.9, P < 0.001) scores at the last follow-up (22.0 ± 14.3 months), compared with scores at baseline, with a mean improvement of 56.6% (P < 0.001) (54.9% in severity, 63.2% in disability, 41.7% in pain). There was no significant difference in the improvement (%) of the total TWSTRS scores in 3 years for the GPI and STN groups (58.1 ± 22.6 vs 47.5 ± 39.2, P > 0.05). Age at surgery and age at symptom onset were negatively correlated with the relative changes in TWSTRS scores at the last follow-up, while there was a positive correlation with preoperative TWSTRS scores. On the stepwise multivariate regression, only the age at surgery remained significant in the best predictive model. CONCLUSIONS:GPi-DBS and STN-DBS both provided a common great improvement in the symptoms of CDpatients in 3 years. Earlier age at surgery may probably indicate larger improvement. More randomized large-scale clinical trials are warranted in the future.
Authors: A R Bentivoglio; E Di Stasio; D Mulas; M L Cerbarano; T Ialongo; A Laurienzo; Martina Petracca Journal: Neurotox Res Date: 2017-05-06 Impact factor: 3.911
Authors: A Albanese; F Asmus; K P Bhatia; A E Elia; B Elibol; G Filippini; T Gasser; J K Krauss; N Nardocci; A Newton; J Valls-Solé Journal: Eur J Neurol Date: 2011-01 Impact factor: 6.089
Authors: John Yianni; Peter Bain; Nir Giladi; Marieta Auca; Ralph Gregory; Carole Joint; Dipankar Nandi; John Stein; Richard Scott; Tipu Aziz Journal: Mov Disord Date: 2003-04 Impact factor: 10.338