Therapeutic Interventions for Vascular Parkinsonism: A Systematic Review and Meta-analysis
Por:
Miguel-Puga, Adan, Villafuerte, Gabriel, Salas-Pacheco, Jose, Arias-Carrion, Oscar
Publicada:
22 sep 2017
Resumen:
Background: Vascular parkinsonism (VP) is defined as the presence of
parkinsonian syndrome, evidence of cerebrovascular disease, and an
established relationship between the two disorders. However, the
diagnosis of VP is problematic, particularly for the clinician
confronted with moving from diagnosis to treatment. Given the different
criteria used in the diagnosis of VP, the effectiveness of available
therapeutic interventions for this disease are currently unknown.
Methods: To assess the clinical response of all published therapeutic
interventions for VP that have been reported in the literature, we
conducted a systematic review looking for VP subjects treated with any
therapeutic intervention. To clarify the prevalence of responsiveness to
levodopa among VP subjects, we conducted a meta-analysis of 17
observational studies retrieved with the search criteria of our review.
Also, four studies were included in a second analysis to explore if
nigrostriatal lesion affected the prevalence of levodopa response in VP
subjects. Relevant articles were identified from MEDLINE, Scopus, and
Web of Science published until June 2017.
Results: 436 non-duplicate citations were identified for screening, 107
articles were assessed for eligibility, and only 23 observational
studies were included in this review. No randomized clinical trials were
found. Four different therapies were found in the literature; among
them, levodopa was the only one repetitively reported. The calculated
event rate of levodopa response in VP subjects was of 0.304 [95%
confidence interval (Cl) of 0.230-0.388]. The overall odds ratio for
good response to levodopa in VP with lesion in the nigrostriatal pathway
vs. no lesion in the nigrostriatal pathway was 15.15 (95% Cl:
5.2-44.17).
Conclusion: Despite the lack of randomized controlled trials, results of
this systematic review and meta-analysis show that VP subjects, as
operationally defined here, have a low response rate to levodopa;
nigrostriatal lesion could be used as a proxy predictor of levodopa
response in VP subjects. Other therapies seem to be co-adjuvant.
Randomized controlled trials with a clear definition of VP are necessary
to be able to assign positive or negative predictive values to available
treatments and to recommend any of the therapeutic interventions for
these subjects.
Filiaciones:
Miguel-Puga, Adan:
Hosp Gen Dr Manuel Gea Gonzalez, Unidad Trastomos Movimiento & Sueno TMS, Mexico City, DF, Mexico
Univ Nacl Autonoma Mexico, Fac Med, PECEM, Mexico City, DF, Mexico
Villafuerte, Gabriel:
Hosp Gen Dr Manuel Gea Gonzalez, Unidad Trastomos Movimiento & Sueno TMS, Mexico City, DF, Mexico
Univ Nacl Autonoma Mexico, Fac Med, PECEM, Mexico City, DF, Mexico
Salas-Pacheco, Jose:
Univ Juarez Estado Durango, Inst Invest Cient, Durango, Mexico
Arias-Carrion, Oscar:
Hosp Gen Dr Manuel Gea Gonzalez, Unidad Trastomos Movimiento & Sueno TMS, Mexico City, DF, Mexico
Hosp Gen Dr Manuel Gea Gonzalez, CIMA, Mexico City, DF, Mexico
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