Comparison of efficacy of deep brain stimulation and focused ultrasound in parkinsonian tremor: a systematic review and network meta-analysis

2021 ◽  
Vol 92 (4) ◽  
pp. 434-443
Author(s):  
Fabin Lin ◽  
Dihang Wu ◽  
Jiao Yu ◽  
Huidan Weng ◽  
Lina Chen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Focused Ultrasound ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Internal Globus Pallidus ◽  
Parkinsonian Tremor ◽  
Tremor Suppression ◽  
Stn Dbs ◽  
Deep Brain

To compare the efficacy of deep brain stimulation (DBS) and MRI-guided focused ultrasound (MRIgFUS) in parkinsonian tremor. We performed a network meta-analysis based on a Bayesian framework. We searched the literature for articles published between January 1990 and October 2020 using three databases: PubMed, Embase and Cochrane Library (The Cochrane Database of Systematic Reviews). A total of 24 studies were included in our analysis, comprising data from 784 participants. Our findings revealed similar efficacy of DBS and MRIgFUS in parkinsonian tremor suppression. Compared with internal globus pallidus (GPi)-MRIgFUS, GPi-DBS -1.84 (–6.44, 2.86), pedunculopontine nucleus (PPN)_DBS –3.28 (–9.28, 2.78), PPN and caudal zona incerta (cZI)-DBS 0.40 (–6.16, 6.87), subthalamic nucleus (STN)_DBS 0.89 (–3.48, 5.30), STN and cZI-DBS 1.99 (–4.74, 8.65), ventral intermediate nucleus(VIM)_DBS 1.75 (–2.87, 6.48), VIM_FUS 0.72 (–5.27, 6.43), cZI-DBS 0.27 (–4.75, 5.36) were no significantly difference. Compared with VIM-MRIgFUS, GPi-DBS -2.55(-6.94, 2.21), GPi-FUS -0.72 (–6.43, 5.27), PPN_DBS -4.01(–9.97, 2.11), PPN and cZI-DBS -0.32 (-6.73, 6.36), STN_DBS 0.16 (–3.98, 4.6), STN and cZI-DBS 1.31(-5.18,7.87), VIM-DBS 1.00(-3.41, 5.84)and cZI-DBS –0.43 (–5.07, 4.68) were no significantly difference. With respect to the results for the treatment of motor symptoms, GPi-DBS, GPi-MRIgFUS, STN-DBS and cZI-DBS were significantly more efficacious than baseline (GPi-DBS 15.24 (5.79, 24.82), GPi-MRIgFUS 13.46 (2.46, 25.10), STN-DBS 19.62 (12.19, 27.16), cZI-DBS 14.18 (1.73, 26.89). The results from the surface under the cumulative ranking results showed that STN-DBS ranked first, followed by combined PPN and cZI-DBS, and PPN-DBS ranked last. MRIgFUS, an efficacious intervention for improving parkinsonian tremor, has not demonstrated to be inferior to DBS in parkinsonian tremor suppression. Hence, clinicians should distinguish individual patients’ symptoms to ensure that the appropriate intervention and therapeutic approach are applied.

scholarly journals A Meta-Analysis of the Effect of Subthalamic Nucleus-Deep Brain Stimulation in Parkinson's Disease-Related Pain

2021 ◽  
Vol 15 ◽  
Author(s):  
Yu Diao ◽  
Yutong Bai ◽  
Tianqi Hu ◽  
Zixiao Yin ◽  
Huangguang Liu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Motor Symptom ◽  
Stn Dbs ◽  
Deep Brain

Pain from Parkinson's disease (PD) is a non-motor symptom affecting the quality of life and has prevalence of 20–80%. However, it is unclear whether subthalamic nucleus deep brain stimulation (STN–DBS), a well-established treatment for PD, is effective forPD-related pain. Thus, the objective of this meta-analysis was to investigate the efficacy of STN-DBS on PD-related pain and explore how its duration affects the efficacy of STN-DBS. A systematic search was performed using PubMed, Embase, and the Cochrane Library. Nine studies included numerical rating scale (NRS), visual analog scale (VAS), or non-motor symptom scale (NMSS) scores at baseline and at the last follow-up visit and therefore met the inclusion criteria of the authors. These studies exhibited moderate- to high-quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. Random effect meta-analysis revealed a significant change in PD-related pain as assessed by NMSS, NRS, and VAS (P <0.01). Analysis of the short and long follow-up subgroups indicated delayed improvement in PD-related pain. These findings (a) show the efficacy of STN-DBS on PD-related pain and provide higher-level evidence, and (b) implicate delayed improvement in PD-related pain, which may help programming doctors with supplement selecting target and programming.Systematic Review Registration: This study is registered in Open Science Framework (DOI: 10.17605/OSF.IO/DNM6K).

Target Selection for Parkinson Disease With Medication-Refractory Unilateral Resting Tremor

2020 ◽  
pp. 55-58
Author(s):  
Fuyuko Sasaki ◽  
Yasushi Shimo ◽  
Nobutaka Hattori
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Target Selection ◽  
Postural Tremor ◽  
Parkinsonian Tremor ◽  
Postural Reflexes ◽  
Tremor Suppression ◽  
Bothersome Symptom ◽  
History Of ◽  
Stn Dbs

A 67-year-old, right-handed man had a 7-year history of right-dominant, severe medication-refractory resting and action-postural tremor, rigidity, bradykinesia, and impairment of postural reflexes, with his symptoms poorly responsive to oral antiparkinsonian medication. His parkinsonian symptoms with the exception of tremor responded to levodopa infusion. His most bothersome symptom was tremor, and implantation of a left subthalamic nucleus (STN) deep brain stimulation (DBS) lead was pursued with possible posterior subthalamic area (PSA) DBS if the tremor suppression by STN was not intraoperatively sufficient. Ultimately, the STN DBS lead provided reasonable tremor suppression during the operation, and there was no need for PSA DBS. After the surgery, his tremor and other parkinsonian symptoms were well-controlled. This case highlights that unilateral STN DBS is a reasonable indication for medication-refractory parkinsonian tremor with significant laterality of bothersome symptoms, although other options may also be considered.

scholarly journals Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

2014 ◽  
Vol 27 (3) ◽  
pp. 372 ◽  
Author(s):  
Maria Inês Couto ◽  
Ana Monteiro ◽  
Ana Oliveira ◽  
Nuno Lunet ◽  
João Massano
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Depressive Symptoms ◽  
Deep Brain Stimulation ◽  
Medical Treatment ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Short Term ◽  
Stn Dbs ◽  
Deep Brain

<p><strong>Introduction:</strong> Deep brain stimulation (DBS) is effective in advanced Parkinson’s disease (PD), improving motor symptoms, fluctuations and quality of life. However, adverse psychiatric outcomes have been reported, albeit variably and in an unstandardized fashion. We aimed to summarize the published evidence on the outcomes of anxiety and depressive symptoms in Parkinson’s disease patients following DBS, through systematic review and meta-analysis.<br /><strong>Material and Methods:</strong> PubMed was searched until May 2012 to identify studies assessing anxiety and depressive symptoms in PD patients who underwent bilateral DBS of the subthalamic nucleus (STN) or globus pallidus internus (GPi). Random effects metaanalyses were conducted for groups of at least three studies that were homogeneous regarding the design and the instruments used.<br /><strong>Results:</strong> 63 references were selected; 98.4% provided data on depression, and 38.1% on anxiety assessment scales. Two studies did not discriminate the target; from the remaining 61 references, short-term evaluation was performed in 37 (60.7%), mid-term in 36 (59.0%) and long-term in 5 (8.2%). Data on pre to postop variation was available in 57 (93.4%) reports and 16 (26.2%) presented STNDBS versus different comparison groups: GPi-DBS (n = 4 studies, 25.0%), eligible for surgery (n = 6, 37.5%), and medical treatment (n = 7, 43.8%).<br /><strong>Discussion:</strong> Improvement of depression and anxiety is apparent after DBS, more pronounced in the short-term, an effect that seems to wane in later assessments. Concerning depression, STN-DBS shows superiority against medical treatment, but not when compared to eligible for surgery control groups. The opposite is apparent for anxiety, as results favor medical treatment over STN-DBS, and STNDBS over eligible for surgery control group. Superiority of one target over the other is not evident from the results, but data slightly favors GPi for both outcomes.<br /><strong>Conclusion:</strong> The pattern and course of depressive symptoms and anxiety following DBS in PD is not clear, although both seem to improve in the short-term, especially depression following STN-DBS. Results are highly heterogeneous. Efforts should be carried out to standardize assessment procedures across centers.<br /><strong>Keywords:</strong> Parkinson’s Disease; Deep Brain Stimulation; Anxiety; Depression; Meta-Analysis.</p>

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

2014 ◽  
Vol 121 (3) ◽  
pp. 709-718 ◽  
Author(s):  
Yi Liu ◽  
Weina Li ◽  
Changhong Tan ◽  
Xi Liu ◽  
Xin Wang ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Motor Function ◽  
Brain Stimulation ◽  
Daily Living ◽  
Psychiatric Symptoms ◽  
Meta Analysis ◽  
Stn Dbs ◽  
Deep Brain ◽  
Stimulation Of

Object Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). The globus pallidus internus (GPi) and the subthalamic nucleus (STN) are commonly targeted by this procedure. The purpose of this meta-analysis was to compare the efficacy of DBS in each region. Methods MEDLINE/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library were searched for English-language studies published before April 2013. Results of studies investigating the efficacy and clinical outcomes of DBS of the GPi and STN for PD were analyzed. Results Six eligible trials containing a total of 563 patients were included in the analysis. Deep brain stimulation of the GPi or STN equally improved motor function, measured by the Unified Parkinson's Disease Rating Scale Section III (UPDRSIII) (motor section, for patients in on- and off-medication phases), within 1 year postsurgery. The change score for the on-medication phase was 0.68 (95% CI – 2.12 to 3.47, p > 0.05; 5 studies, 518 patients) and for the off-medication phase was 1.83 (95% CI – 3.12 to 6.77, p > 0.05; 5 studies, 518 patients). The UPDRS Section II (activities of daily living) scores for patients on medication improved equally in both DBS groups (p = 0.97). STN DBS allowed medication dosages to be reduced more than GPi DBS (95% CI 129.27–316.64, p < 0.00001; 5 studies, 540 patients). Psychiatric symptoms, measured by Beck Depression Inventory, 2nd edition scores, showed greater improvement from baseline after GPi DBS than after STN DBS (standardized mean difference −2.28, 95% CI −3.73 to −0.84, p = 0.002; 3 studies, 382 patients). Conclusions GPi and STN DBS improve motor function and activities of daily living for PD patients. Differences in therapeutic efficacy for PD were not observed between the 2 procedures. STN DBS allowed greater reduction in medication for patients, whereas GPi DBS provided greater relief from psychiatric symptoms. An understanding of other symptomatic aspects of targeting each region and long-term observations on therapeutic effects are needed.

scholarly journals Deep Brain Stimulation in Treatment-Resistant Depression: A Systematic Review and Meta-Analysis on Efficacy and Safety

2021 ◽  
Vol 15 ◽  
Author(s):  
Youliang Wu ◽  
Jiajie Mo ◽  
Lisen Sui ◽  
Jianguo Zhang ◽  
Wenhan Hu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Deep Brain

Objective: Deep brain stimulation (DBS) has shown promising outcomes as new therapeutic opportunities for patients with treatment-resistant depression (TRD) who do not respond adequately to several consecutive treatments. This study aims to systematically review and conduct a meta-analysis on the efficacy and safety of DBS for TRD.Method: The literature was comprehensively reviewed using Medline, Google scholar, Cochrane library, Embase, and World Health Organization International Clinical Trials Registry Platform until January 2019. The studied outcomes included response, remission, recurrence, and adverse events (AEs) rates, and were reported as the rate ratio (RR) or pooled estimate with a 95% confidence interval (95% CI). Heterogeneity was measured by an I-square test and a sensitive analysis.Results: A total of 17 studies involving 7 DBS targets were included. For efficacy, DBS treatment was statistically beneficial for TRD, and the response, remission, and recurrence rates were 56% (ranging from 43 to 69%), 35% (ranging from 27 to 44%), and 14% (ranging from 4 to 25%), respectively. However, only two randomized-controlled trials (RCTs) considered the invalidity of DBS (RR = 1.45, 95% CI = 0.50–4.21). For safety, the AEs rate was 67% (ranging from 54 to 80%). The AEs were common and moderate, but the problems related to suicide and suicidal ideation should not be underestimated.Conclusion: These findings suggest that DBS for TRD is considered promising, which should be confirmed by well-designed and large sample studies. Future basic research and comprehensive clinical trials are needed to reach better understanding on the mechanisms of action and optimal targeted structure.

STN vs. GPi deep brain stimulation for tremor suppression in Parkinson disease: A systematic review and meta-analysis

2019 ◽  
Vol 58 ◽  
pp. 56-62 ◽  
Author(s):  
Joshua K. Wong ◽  
James H. Cauraugh ◽  
Kwo Wei David Ho ◽  
Matthew Broderick ◽  
Adolfo Ramirez-Zamora ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Tremor Suppression ◽  
Deep Brain

scholarly journals Apathy following Bilateral Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Ying Wang ◽  
Yongsheng Li ◽  
Xiaona Zhang ◽  
Anmu Xie
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Significant Difference ◽  
Stn Dbs ◽  
Deep Brain ◽  
Stimulation Of

Bilateral deep brain stimulation of subthalamic nucleus (STN-DBS) has proven effective in improving motor symptoms in Parkinson’s disease (PD) patients. However, psychiatric changes after surgery are controversial. In this study, we specifically analyzed apathy following bilateral STN-DBS in PD patients using a meta-analysis. Relevant articles utilized for this study were obtained through literature search on PubMed, ScienceDirect, and Embase databases. The articles included were those contained both pre- and postsurgery apathy data acquired using the Starkstein Apathy Scale or Apathy Evaluation Scale with patient follow-up of at least three months. A total of 9 out of 86 articles were included in our study through this strict screening process. Standardized mean difference (SMD), that is, Cohen’s d, with a 95% confidence interval (CI) was calculated to show the change. We found a significant difference between the presurgery stage and the postsurgery stage scores (SMD = 0.35, 95% CI: 0.17∼0.52, P<0.001). STN-DBS seems to relatively worsen the condition of apathy, which may result from both the surgery target (subthalamic nucleus) and the reduction of dopaminergic medication. Further studies should focus on the exact mechanisms of possible postoperative apathy in the future.

scholarly journals Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies

2015 ◽  
Vol 43 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Laleh Golestanirad ◽  
Behzad Elahi ◽  
Simon J. Graham ◽  
Sunit Das ◽  
Lawrence L. Wald
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Freezing Of Gait ◽  
Pedunculopontine Nucleus ◽  
Postural Instability ◽  
Internal Globus Pallidus ◽  
Motor Abnormalities ◽  
Deep Brain

AbstractBackground: Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients. Methods: PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis. Results: Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait. Conclusions: Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.

scholarly journals A Systematic Review and Meta-Analysis of Deep Brain Stimulation for Progressive Supranuclear Palsy

2020 ◽  
Author(s):  
Yafei Wen ◽  
Bin Jiao ◽  
Yafang Zhou ◽  
Lu Shen
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Progressive Supranuclear Palsy ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Design Strategies ◽  
Deep Brain

Abstract Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease and currently no effective symptomatic or neuroprotective treatment is available for PSP. Deep brain stimulation (DBS), as a neurosurgical procedure, plays an important role in a range of neurological and psychiatric disorders. However, there are no systematic investigations about the DBS in PSP patients. Objective: We performed a systematic review and meta-analysis to evaluate the safety and efficacy of DBS for PSP. Methods: PubMed, EMBASE, Cochrane library, Chinese National Knowledge Infrastructure and Wan Fang databases were systematically searched without time restrictions. We assessed the data between DBS-OFF and DBS-ON groups, as measured by the Unifed Parkinson Disease Rating Scale (UPDRS). Results: Of 154 identified studies, 13 were eligible and were included in our meta-analysis (N = 36 participants). A reduction of UPDRS Ⅲ scores under DBS-ON conditions was observed, but the differences yielded no statistical significance. Conclusion: Since part of PSP patients could benefit from DBS, we speculate that DBS may become a safe and promising tool for PSP in axial symptoms as well as non-motor symptoms though further investgations are needed. Our findings will provide design strategies for following clinical trials and ultimately help improve the clinical application of DBS in PSP patients.

scholarly journals Effect of Deep Brain Stimulation on Parkinson’s Disease Dementia: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-16
Author(s):  
Ali Razmkon ◽  
◽  
Saeed Abdollahifard ◽  
Hirad Rezaei ◽  
Amir Reza Bahadori ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cognitive Deficits ◽  
Rating Scale ◽  
Meta Analysis ◽  
Mattis Dementia Rating Scale ◽  
Stn Dbs ◽  
Deep Brain

Patients in the early stages of Parkinson’s disease(PD) may have subtle cognitive deficits, while overt cognitive deficits are usually manifestations of late-stage PD. There is still a debate on the outcome of deep brain stimulation (DBS) on cognitive function of PD patients. This study aimed to investigate the effect of subthalamic nucleus(STN)-DBS on dementia of PD patients after surgery as compared to medical therapy and other procedures. We searched PubMed, Scopus, Cochrane library and Web of Science database in 22th October 2020. The words Deep Brain stimulation, Parkinson’s disease, dementia, and memory have been searched. Reviews, abstracts, case presentations and letters were excluded. Totally, 490 studies were screened after removing the duplicates. The screening results yielded 81 articles to be screened for eligibility. Finally, 6 studies were included in this meta-analysis for synthesis. Overall, 800 patients were included in this meta-analysis, using Mattis dementia rating scale (MDRS) along with descriptive data of the articles was extracted for assessment of global dementia. Our results indicated that STN-DBS group showed a larger cognitive decline than the best medical treatment(BMT). DBS diminished the score of Mattis dementia rating scale in PD patients more than BMT. The effect of STN-DBS vs. other procedures on dementia was not significant; our results showed that STN stimulation made no significant change in global dementia of PD patients in midterm compared to GPi, Pallidal stimulation and pallidotomy.

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