癫痫患者植入式迷走神经刺激相关的嗓音改变：系统综述与荟萃分析

文献信息

中文摘要

目的： 植入式迷走神经刺激（VNS）是药物难治性癫痫的成熟治疗方法。然而，刺激相关的嗓音障碍是最常报告的不良反应之一。本系统综述与荟萃分析综合了关于癫痫患者植入式VNS相关嗓音结局的现有证据。
研究设计： 系统综述与荟萃分析。
方法： 按照PRISMA指南对PubMed、Scopus和Web of Science进行了系统检索。评估癫痫患者植入式VNS相关声学、感知、空气动力学、发声、喉部或患者报告嗓音结局的研究符合纳入标准。采用Joanna Briggs Institute批判性评价工具和ROBINS-I评估方法学质量。采用GRADE方法评价证据确定性。对对照研究中报告的结局进行随机效应荟萃分析。
结果： 13项发表于1993年至2024年间的研究符合纳入标准，包括病例报告、病例系列、观察性研究以及两项对照比较研究。定性综合一致显示，在主动刺激期间jitter和shimmer增加、最长发声时间（MPT）缩短、感知性嗓音恶化以及嗓音相关障碍加重。定量综合显示，植入式VNS参与者的MPT短于健康对照者（MD = -8.66 s，95% CI -11.31至-6.01；P < 0.00001）。VNS参与者在嗓音障碍指数功能性领域（MD = 6.58，95% CI 4.13-9.04；P < 0.00001）和生理领域（MD = 8.49，95% CI 3.40-13.58；P = 0.001）的评分也显著更高。证据确定性范围为低至极低。
结论： 植入式VNS似乎与嗓音功能改变相关，包括发声效率降低、声学扰动增加以及自我感知的嗓音障碍加重。尽管证据确定性仍然有限，但研究结果的一致性和荟萃分析结果支持VNS相关嗓音效应具有临床相关性。对于因药物难治性癫痫接受植入式VNS的患者，应考虑将常规嗓音监测作为其长期临床管理的一部分。

英文摘要

OBJECTIVE: Implanted vagus nerve stimulation (VNS) is an established treatment for drug-resistant epilepsy. However, stimulation-related voice disturbances are among the most frequently reported adverse effects. This systematic review and meta-analysis synthesized available evidence regarding voice outcomes associated with implanted VNS in patients with epilepsy.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: A systematic search of PubMed, Scopus, and Web of Science was conducted following PRISMA guidelines. Studies evaluating acoustic, perceptual, aerodynamic, phonatory, laryngeal, or patient-reported voice outcomes associated with implanted VNS in epilepsy were eligible. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools and ROBINS-I. Evidence certainty was evaluated using the GRADE approach. Random-effects meta-analyses were performed for outcomes reported in controlled studies.
RESULTS: Thirteen studies published between 1993 and 2024 met the inclusion criteria, comprising case reports, case series, observational studies, and two controlled comparative studies. Qualitative synthesis consistently demonstrated increased jitter and shimmer during active stimulation, reduced maximum phonation time (MPT), perceptual voice deterioration, and greater voice-related handicap. Quantitative synthesis demonstrated shorter MPT in participants with implanted VNS than in healthy controls (MD = -8.66 s, 95% CI -11.31 to -6.01; P < 0.00001). Participants with VNS also showed significantly higher scores in the functional (MD = 6.58, 95% CI 4.13-9.04; P < 0.00001) and physical (MD = 8.49, 95% CI 3.40-13.58; P = 0.001) domains of the Voice Handicap Index. Evidence certainty ranged from low to very low.
CONCLUSIONS: Implanted VNS appears to be associated with alterations in voice function, including reduced phonatory efficiency, increased acoustic perturbation, and greater self-perceived vocal handicap. Although evidence certainty remains limited, the consistency of findings and meta-analytic results support clinically relevant VNS-related voice effects. Routine voice monitoring should be considered as part of the long-term clinical management of patients receiving implanted VNS for drug-resistant epilepsy.