Lachenmayer, M. Lenard; Mürset, Melina; Antih, Nicolas; Debove, Ines; Muellner, Julia; Bompart, Maëlys; Schläppi, Janine Ai; Nowacki, Andreas; You, Hana; Michelis, Joan P.; Dransart, Alain; Pollo, Claudio; Deuschl, Guenther; Krack, Paul (2021). Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes. NPJ Parkinson's disease, 7(1), p. 77. Nature Publishing Group 10.1038/s41531-021-00223-5
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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.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery |
UniBE Contributor: |
Lachenmayer, Lenard, Debove, Ines, Müllner, Julia Nicole Maria, Schläppi, Janine Ai, Nowacki, Andreas, You, Hana, Michelis, Joan Philipp, Pollo, Claudio, Krack, Paul |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2373-8057 |
Publisher: |
Nature Publishing Group |
Language: |
English |
Submitter: |
Nicole Söll |
Date Deposited: |
05 Nov 2021 11:29 |
Last Modified: |
05 Dec 2022 15:53 |
Publisher DOI: |
10.1038/s41531-021-00223-5 |
PubMed ID: |
34489472 |
BORIS DOI: |
10.48350/159935 |
URI: |
https://boris.unibe.ch/id/eprint/159935 |
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