■原发性震颤(ET)是一种常见的神经系统疾病。脑深部刺激(DBS)丘脑腹侧中间核(VIM)或邻近结构,如尾带不完整/丘脑后区(cZi/PSA),可有效治疗药物难治性震颤。然而,目前尚不清楚DBS是否会引起认知变化,在哪个领域,如果是这样,在多大程度上。
■我们系统地搜索了PubMed和WebofScience,以获取有关PICO后接受DBS的ET患者认知结果的可用出版物(人群,干预,比较器,和结果)概念。采用了PRISMA系统评价指南。
■最终确定并纳入了20篇相关文章以供审查,其中13项为前瞻性(1项也是随机的)研究,7项为回顾性研究.认知结果包括注意力,记忆,执行功能,语言,视觉空间功能,和情绪相关的变量。VIM和cZi/PSADBS的耐受性普遍良好,尽管一些患者的言语流畅性和语言能力受到影响。此外,左侧VIMDBS对言语抽象有负面影响,单词回忆,和一些患者的言语记忆表现。
■ET患者在VIM或cZi/PSADBS后出现明显的认知功能下降似乎很少见。未来需要前瞻性随机对照试验来仔细研究该地点的影响,偏侧性,以及积极接触者对认知结果的刺激参数,同时考虑DBS后可能的药物变化,定时,标准神经心理学电池,实践效果,评估的时机,和效应大小作为潜在的混杂因素。
UNASSIGNED: Essential tremor (ET) is a common neurological disease. Deep brain stimulation (DBS) to the thalamic ventral intermediate nucleus (VIM) or the adjacent structures, such as caudal zona incerta/ posterior subthalamic area (cZi/PSA), can be effective in treating medication refractory tremor. However, it is not clear whether DBS can cause cognitive changes, in which domain, and to what extent if so.
UNASSIGNED: We systematically searched PubMed and the Web of Science for available publications reporting on cognitive outcomes in patients with ET who underwent DBS following the PICO (population, intervention, comparators, and outcomes) concept. The PRISMA guideline for systematic reviews was applied.
UNASSIGNED: Twenty relevant articles were finally identified and included for
review, thirteen of which were prospective (one also randomized) studies and seven were retrospective. Cognitive outcomes included attention, memory, executive function, language, visuospatial function, and mood-related variables. VIM and cZi/PSA DBS were generally well tolerated, although verbal fluency and language production were affected in some patients. Additionally, left-sided VIM DBS was associated with negative effects on verbal abstraction, word recall, and verbal memory performance in some patients.
UNASSIGNED: Significant cognitive decline after VIM or cZi/PSA DBS in ET patients appears to be rare. Future prospective randomized controlled trials are needed to meticulously study the effect of the location, laterality, and stimulation parameters of the active contacts on cognitive outcomes while considering possible medication change post-DBS, timing, standard neuropsychological battery, practice effects, the timing of assessment, and effect size as potential confounders.