Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes
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-...
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2021-09-01
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doaj-0df4e7c9503048c093e5ad31980029d82021-09-12T11:28:26ZengNature Publishing Groupnpj Parkinson's Disease2373-80572021-09-017111010.1038/s41531-021-00223-5Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomesM. Lenard Lachenmayer0Melina Mürset1Nicolas Antih2Ines Debove3Julia Muellner4Maëlys Bompart5Janine-Ai Schlaeppi6Andreas Nowacki7Hana You8Joan P. Michelis9Alain Dransart10Claudio Pollo11Guenther Deuschl12Paul Krack13Department of Neurology, Inselspital, Bern University Hospital, University of BernDepartment of Neurology, Inselspital, Bern University Hospital, University of BernAleva Neurotherapeutics SADepartment of Neurology, Inselspital, Bern University Hospital, University of BernDepartment of Neurology, Inselspital, Bern University Hospital, University of BernAleva Neurotherapeutics SADepartment of Neurosurgery, Inselspital, Bern University Hospital, University of BernDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of BernDepartment of Neurology, Inselspital, Bern University Hospital, University of BernDepartment of Neurology, Inselspital, Bern University Hospital, University of BernAleva Neurotherapeutics SADepartment of Neurosurgery, Inselspital, Bern University Hospital, University of BernDepartment of Neurology, UKSH, Christian-Albrechts-UniversityDepartment of Neurology, Inselspital, Bern University Hospital, University of BernAbstract 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.https://doi.org/10.1038/s41531-021-00223-5 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
M. Lenard Lachenmayer Melina Mürset Nicolas Antih Ines Debove Julia Muellner Maëlys Bompart Janine-Ai Schlaeppi Andreas Nowacki Hana You Joan P. Michelis Alain Dransart Claudio Pollo Guenther Deuschl Paul Krack |
spellingShingle |
M. Lenard Lachenmayer Melina Mürset Nicolas Antih Ines Debove Julia Muellner Maëlys Bompart Janine-Ai Schlaeppi Andreas Nowacki Hana You Joan P. Michelis Alain Dransart Claudio Pollo Guenther Deuschl Paul Krack Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes npj Parkinson's Disease |
author_facet |
M. Lenard Lachenmayer Melina Mürset Nicolas Antih Ines Debove Julia Muellner Maëlys Bompart Janine-Ai Schlaeppi Andreas Nowacki Hana You Joan P. Michelis Alain Dransart Claudio Pollo Guenther Deuschl Paul Krack |
author_sort |
M. Lenard Lachenmayer |
title |
Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes |
title_short |
Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes |
title_full |
Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes |
title_fullStr |
Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes |
title_full_unstemmed |
Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes |
title_sort |
subthalamic and pallidal deep brain stimulation for parkinson’s disease—meta-analysis of outcomes |
publisher |
Nature Publishing Group |
series |
npj Parkinson's Disease |
issn |
2373-8057 |
publishDate |
2021-09-01 |
description |
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. |
url |
https://doi.org/10.1038/s41531-021-00223-5 |
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