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Risk of fall with device-based advanced treatments in Parkinson’s disease: a systematic review and network meta-analysis

医学 荟萃分析 脑深部刺激 子群分析 内科学 帕金森病 梅德林 疾病 政治学 法学
作者
Rajasumi Rajalingam,Gianluca U. Sorrento,Alfonso Fasano
出处
期刊:Journal of Neurology, Neurosurgery, and Psychiatry [BMJ]
卷期号:: jnnp-334521 被引量:1
标识
DOI:10.1136/jnnp-2024-334521
摘要

Background Deep brain stimulation (DBS) and infusion therapies are effective treatments for the motor complications of Parkinson’s disease (PD), but less established is their role in fall prevention. This systematic review and network meta-analysis (NMA) aimed to evaluate the risk of falls associated with advanced therapies in PD. Methods Following PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Network Meta-analyses) guidelines, we searched PubMed, Medline, Embase and CINAHL up to 20 March 2024. Eligibility criteria based on PICOS (Population Intervention Control Outcome Study design) framework were used for DBS of the subthalamic nucleus (STN) or globus pallidus pars interna (GPi), or infusion therapies, compared with best medical treatment (BMT) or sham stimulation. Pairwise meta-analysis was conducted using RevMan V.5.4, and NMA using the netmeta package in R software. Results Fourteen studies were included. A higher number of falls were observed in the DBS group compared with BMT, although the difference was not significant. Sensitivity analysis excluding a heterogeneity-contributing study showed a significantly higher fall risk in the DBS group (Risk Ratio (RR)=2.74, 95% CI 1.60, 4.67, p=0.0002). Subgroup analyses indicated that levodopa-carbidopa intestinal gel tended towards increased fall risk, while continuous subcutaneous infusion of (fos)levodopa (CSCI) significantly decreased risk with high certainty of evidence. NMA showed CSCI as the most effective in reducing falls, while STN DBS was associated with the highest risk. Conclusions DBS, especially targeting the STN, may increase fall risk compared with other advanced non-DBS procedures. While LCIG might not alter fall risk, preliminary evidence suggests that CSCI positively affects fall prevention. PROSPERO registration number CRD42023420637.
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