Efficacy and Safety of Deep Brain Stimulation in the Treatment of Parkinson's Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Sosipatros P Bratsos,Sohag N Saleh,Dimitrios Karponis

doi:10.7759/cureus.3474

Sosipatros P Bratsos, Sohag N Saleh + Show 1 more

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https://doi.org/10.7759/cureus.3474

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Journal: Cureus	Publication Date: Oct 22, 2018
Citations: 32	License type: cc-by

Affiliation: Imperial College London

Abstract

Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson’s disease (PD). Whether similar benefits may be realized by patients with early PD, however, is currently unclear, especially given the potential risks of the procedure. This systematic review and meta-analysis aimed to investigate the relative efficacy and safety of DBS in comparison to best medical therapy (BMT) in the treatment of PD. It also aimed to compare the efficacy of DBS between patients with early and advanced PD.A systematic search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) comparing DBS to BMT in PD patients were included. Outcome measures were impairment/disability using the Unified Parkinson’s Disease Rating Scale (UPDRS), quality of life (QoL) using the Parkinson's Disease Questionnaire (PDQ-39), levodopa equivalent dose (LED) reduction, and rates of serious adverse events (SAE).Eight eligible RCTs (n = 1,189) were included in the meta-analysis, two of which recruited early PD patients. Regarding efficacy outcomes, there were significant improvements in UPDRS, PDQ-39, and LED scores in favour of DBS (P < 0.00001). There was a significantly greater reduction of LED in patients with early PD (P < 0.00001), but no other differences between early and advanced PD patients were found. The risk of a patient experiencing an SAE was significantly higher in the DBS group (P = 0.005), as was the total number of SAEs (P < 0.00188).Overall, DBS was superior to BMT at improving impairment/disability, QoL, and reducing medication doses, but these benefits need to be weighed against the higher risk of SAEs. There was insufficient evidence to determine the impact of the PD stage on the efficacy of DBS.

Highlights

BackgroundParkinson’s diseaseParkinson’s disease (PD) is a progressive and debilitating neurodegenerative disorder that affects 0.1 - 0.2% of the population at any time and 1% of the population over 60 years old, with the prevalence increasing in an age-dependent manner [1]
This review aimed to provide a comprehensive overview and quantitative summary of Randomized controlled trials (RCTs) that compared Deep brain stimulation (DBS) (STN, GPi, or other) to best medical therapy (BMT) in terms of efficacy and safety in PD patients
Substantial evidence to support the use of DBS in favour of BMT in the treatment of PD was found, given the observed improvements in motor control, functionality, and quality of life (QoL)

Summary

Introduction

Parkinson’s disease (PD) is a progressive and debilitating neurodegenerative disorder that affects 0.1 - 0.2% of the population at any time and 1% of the population over 60 years old, with the prevalence increasing in an age-dependent manner [1]. It is characterised by motor, autonomic, and neurocognitive impairment. The management of PD focuses on drug therapy and primarily on levodopa, which is regarded as the most effective treatment [5].

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