Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes

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

doi:10.1038/s41531-021-00223-5

Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes

NPJ Parkinsons Dis. 2021 Sep 6;7(1):77. doi: 10.1038/s41531-021-00223-5.

Authors

Affiliations

¹ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. lenard.lachenmayer@insel.ch.
² Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Aleva Neurotherapeutics SA, Lausanne, Switzerland.
⁴ Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.

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.