周围神经刺激治疗特发性震颤：有效性与安全性的系统评价和荟萃分析。
完整摘要 · 中文译文
背景：特发性震颤（ET）是世界上最常见的运动障碍。目前的药物治疗有限，且其副作用往往使患者无法耐受足够剂量。手术治疗，如脑深部电刺激（DBS）和聚焦超声（FUS），保留用于震颤导致日常生活活动（ADLs）受损的患者。周围神经刺激（PNS），包括经皮传入模式刺激（TAPS）和经皮周围神经刺激（TPNS），已成为对许多中等症状患者有前景的非侵入性神经调控方法。 方法：按照PRISMA 2020指南进行了系统综述和荟萃分析，检索了PubMed、Scopus、Cochrane和Web of Science。纳入评估TAPS和TPNS的入组ET患者的研究。主要结局为震颤严重程度（TETRAS表现量表、TETRAS总分）和震颤幅度。次要结局包括功能障碍（BF-ADL、TETRAS-mADL）和安全性。 结果：共纳入19项研究（2，541例患者）。假手术对照分析显示TETRAS表现量表评分有统计学显著改善（MD = - 1.00；p = 0.002；I2 = 0%）。BF-ADL评分在假手术对照分析（MD = - 1.69；p < 0.0001）和单臂前后分析（MD = - 3.22；p < 0.0001）中均显著改善。震颤幅度和TETRAS总分结局不一致，高异质性（I2高达94%）主要由评估时间差异驱动；汇总的TETRAS总分估计未达统计学 差异无统计学意义（p = 0.16）。不良事件大多为轻度且短暂；皮肤刺激是最常报告的不良事件（7.88%），未发生归因于该干预的严重不良事件。 结论：PNS在ET患者中持续改善功能结局，且安全性良好。这些发现支持PNS作为一种可行的辅助性或按需非侵入性治疗选择，尤其适用于药物难治性患者或不适合手术的患者。
完整摘要 · 英文原文
BACKGROUND: Essential tremor (ET) is the most prevalent movement disorder worldwide. There are limited current pharmacological therapies, and their side effects often preclude adequate doses. Surgical therapies, such as Deep Brain Stimulation (DBS) and Focused Ultrasound (FUS), are reserved for patients with tremor that debilitates activities of daily living (ADLs). Peripheral nerve stimulation (PNS), including transcutaneous afferent patterned stimulation (TAPS) and transcutaneous peripheral nerve stimulation (TPNS), has emerged as a promising non-invasive neuromodulatory approach for many patients with intermediate symptoms. METHODS: A systematic review and meta-analysis following PRISMA 2020 guidelines was conducted, with searches across PubMed, Scopus, Cochrane, and Web of Science. Studies enrolling patients with ET assessing TAPS and TPNS were included. Primary outcomes were tremor severity (TETRAS performance scale, total TETRAS) and tremor amplitude. Secondary outcomes included functional disability (BF-ADL, TETRAS-mADL) and safety. RESULTS: Nineteen studies (2,541 patients) were included. Sham-controlled analyses showed statistically significant improvement in TETRAS performance scale scores (MD = - 1.00; p = 0.002; I2 = 0%). BF-ADL scores improved significantly in sham-controlled analyses (MD = - 1.69; p < 0.0001) and single-arm pre-post analyses (MD = - 3.22; p < 0.0001). Tremor amplitude and total TETRAS outcomes were inconsistent, with high heterogeneity (I2 up to 94%) driven mainly by differences in assessment timing; the pooled total TETRAS estimate was not statistically significant (p = 0.16). Adverse events were mostly mild and transient; skin irritation was the most frequently reported (7.88%), and no serious adverse events were attributed to the intervention. CONCLUSIONS: PNS consistently improved functional outcomes with a favorable safety profile in ET patients. These findings support PNS as a viable adjunctive or on-demand non-invasive therapeutic option, particularly for medication-refractory patients or those unsuitable for surgery.