Abstract
Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) and the subthalamic nucleus (STN) has become an established treatment for Parkinson’s disease (PD), a recent meta-analysis of outcomes is lacking. To address this gap, we performed a meta-analysis of bilateral STN- and GPi-DBS studies published from 1990-08/2019. Studies with ≥10 subjects reporting Unified Parkinson’s Disease Rating Scale (UPDRS) III motor scores at baseline and 6–12 months follow-up were included. Several outcome variables were analyzed and adverse events (AE) were summarized. 39 STN studies (2035 subjects) and 5 GPi studies (292 subjects) were eligible. UPDRS-II score after surgery in the stimulation-ON/medication-OFF state compared to preoperative medication-OFF state improved by 47% with STN-DBS and 18.5% with GPi-DBS. UPDRS-III score improved by 50.5% with STN-DBS and 29.8% with GPi-DBS. STN-DBS improved dyskinesia by 64%, daily OFF time by 69.1%, and quality of life measured by PDQ-39 by 22.2%, while Levodopa Equivalent Daily Dose (LEDD) was reduced by 50.0%. For GPi-DBS information regarding dyskinesia, OFF time, PDQ-39 and LEDD was insufficient for further analysis. Correlation analysis showed that preoperative L-dopa responsiveness was highly predictive of the STN-DBS motor outcome across all studies. Most common surgery-related AE were infection (5.1%) and intracranial hemorrhage (3.1%). Despite a series of technological advances, outcomes of modern surgery are still comparable with those of the early days of DBS. Recent changes in target selection with a preference of GPi in elderly patients with cognitive deficits and more psychiatric comorbidities require more published data for validation.
Highlights
IntroductionThe first implantation of deep brain electrodes for tremor in Parkinson’s disease (PD) by Alim-Louis Benabid in the late 1980s in the thalamic ventral intermediate nucleus[1] paved the way for the worldwide application of deep brain stimulation (DBS) in PD.Despite an initial lack of randomized controlled studies, DBS of the subthalamic nucleus (STN) or the internal part of the globus pallidus (GPi) quickly became a well accepted therapy for advanced PD with motor complications due to its convincing effect on motor symptoms, shown by smaller and uncontrolled studies[2,3,4,5,6,7,8,9] and a highly quoted and influential meta-analysis by Kleiner-Fisman and colleagues[10]
This is partly explained by the fact that the results of the existing randomized controlled trials (RCT) are difficult to compare due to their different primary outcomes such as quality of life[13,15,17], time in ON without dyskinesia measured with patient diaries[14,16], motor symptoms (UPDRS-III)[11,12], and functional health measured with a composite score for cognitive, mood, and behavioral effects[18]
According to our inclusion criteria, a majority of studies focused on the subthalamic nucleus (STN) (n = 39) involving 1747 subjects with follow-up data and, to a much lesser extent, the globus pallidus (GPi) (n = 5) with 291 subjects with follow-up data
Summary
The first implantation of deep brain electrodes for tremor in Parkinson’s disease (PD) by Alim-Louis Benabid in the late 1980s in the thalamic ventral intermediate nucleus[1] paved the way for the worldwide application of deep brain stimulation (DBS) in PD.Despite an initial lack of randomized controlled studies, DBS of the subthalamic nucleus (STN) or the internal part of the globus pallidus (GPi) quickly became a well accepted therapy for advanced PD with motor complications due to its convincing effect on motor symptoms, shown by smaller and uncontrolled studies[2,3,4,5,6,7,8,9] and a highly quoted and influential meta-analysis by Kleiner-Fisman and colleagues[10]. The field of DBS has undergone important technical progress, and the efficacy and safety of bilateral STN- and GPi-DBS has been underlined by large randomized controlled trials (RCT)[11,12,13,14,15,16,17,18] and many additional uncontrolled studies, while the choice of the best target remains a matter of controversial debate This is partly explained by the fact that the results of the existing RCTs are difficult to compare due to their different primary outcomes such as quality of life[13,15,17], time in ON without dyskinesia measured with patient diaries[14,16], motor symptoms (UPDRS-III)[11,12], and functional health measured with a composite score for cognitive, mood, and behavioral effects[18]. All studies use the UPDRS, but when comparing UPDRS-III (whether primary or secondary endpoint), outcomes are highly variable across published randomized controlled studies
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
