Tags

Type your tag names separated by a space and hit enter

Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis.
J Neurol. 2020 Jun; 267(6):1780-1792.JN

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.

Authors+Show Affiliations

Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.The Fourth Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China. The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China.Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, East Lake District, Nanchang, 330006, Jiangxi, China.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.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32140866

Citation

Hua, Xing, et al. "Predictive Factors of Outcome in Cervical Dystonia Following Deep Brain Stimulation: an Individual Patient Data Meta-analysis." Journal of Neurology, vol. 267, no. 6, 2020, pp. 1780-1792.
Hua X, Zhang B, Zheng Z, et al. Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis. J Neurol. 2020;267(6):1780-1792.
Hua, X., Zhang, B., Zheng, Z., Fan, H., Luo, L., Chen, X., Duan, J., Zhou, D., Li, M., Hong, T., & Lu, G. (2020). Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis. Journal of Neurology, 267(6), 1780-1792. https://doi.org/10.1007/s00415-020-09765-9
Hua X, et al. Predictive Factors of Outcome in Cervical Dystonia Following Deep Brain Stimulation: an Individual Patient Data Meta-analysis. J Neurol. 2020;267(6):1780-1792. PubMed PMID: 32140866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis. AU - Hua,Xing, AU - Zhang,Bohan, AU - Zheng,Zhicheng, AU - Fan,Houyou, AU - Luo,Linfeng, AU - Chen,Xiaosi, AU - Duan,Jian, AU - Zhou,Dongwei, AU - Li,Meihua, AU - Hong,Tao, AU - Lu,Guohui, Y1 - 2020/03/05/ PY - 2019/11/23/received PY - 2020/02/14/accepted PY - 2020/02/13/revised PY - 2020/3/7/pubmed PY - 2020/3/7/medline PY - 2020/3/7/entrez KW - Cervical dystonia KW - Deep brain stimulation KW - Globus pallidus internus KW - Individual patient data KW - Meta-analysis KW - Predictive factors KW - Subthalamic nucleus SP - 1780 EP - 1792 JF - Journal of neurology JO - J. Neurol. VL - 267 IS - 6 N2 - 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. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/32140866/Predictive_factors_of_outcome_in_cervical_dystonia_following_deep_brain_stimulation:_an_individual_patient_data_meta_analysis_ L2 - https://dx.doi.org/10.1007/s00415-020-09765-9 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.