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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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/0df4e7c9503048c093e5ad31980029d8
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spelling	oai:doaj.org-article:0df4e7c9503048c093e5ad31980029d82021-12-02T17:41:18ZSubthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes10.1038/s41531-021-00223-52373-8057https://doaj.org/article/0df4e7c9503048c093e5ad31980029d82021-09-01T00:00:00Zhttps://doi.org/10.1038/s41531-021-00223-5https://doaj.org/toc/2373-8057Abstract 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.M. Lenard LachenmayerMelina MürsetNicolas AntihInes DeboveJulia MuellnerMaëlys BompartJanine-Ai SchlaeppiAndreas NowackiHana YouJoan P. MichelisAlain DransartClaudio PolloGuenther DeuschlPaul KrackNature PortfolioarticleNeurology. Diseases of the nervous systemRC346-429ENnpj Parkinson's Disease, Vol 7, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurology. Diseases of the nervous system RC346-429 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
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.
format	article
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
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 Portfolio
publishDate	2021
url	https://doaj.org/article/0df4e7c9503048c093e5ad31980029d8
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Subthalamic and pallidal deep brain stimulation for Parkinson’s disease—meta-analysis of outcomes

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