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

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.

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Differential response to pallidal deep brain stimulation among monogenic dystonias: systematic review and meta-analysis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-322169 ◽

2020 ◽

Vol 91 (4) ◽

pp. 426-433 ◽

Cited By ~ 8

Author(s):

Carlo Alberto Artusi ◽

Alok Dwivedi ◽

Alberto Romagnolo ◽

Sara Bortolani ◽

Luca Marsili ◽

...

Keyword(s):

Systematic Review ◽

Deep Brain Stimulation ◽

Linear Regression ◽

Brain Stimulation ◽

Disease Duration ◽

Rating Scale ◽

Meta Analysis ◽

Linear Regression Analysis ◽

Disability Score ◽

Deep Brain

ObjectiveGenetic subtypes of dystonia may respond differentially to deep brain stimulation of the globus pallidus pars interna (GPi DBS). We sought to compare GPi DBS outcomes among the most common monogenic dystonias.MethodsThis systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. We searched PubMed for studies on genetically confirmed monogenic dystonia treated with GPi DBS documenting pre-surgical and post-surgical assessments using the Burke–Fahn–Marsden Dystonia Rating Scale Motor Score (BFMMS) and Burke–Fahn–Marsden Disability Score (BFMDS). We performed (i) meta-analysis for each gene mutation; (ii) weighted ordinary linear regression analyses to compare BFMMS and BFMDS outcomes between DYT-TOR1A and other monogenic dystonias, adjusting for age and disease duration and (iii) weighted linear regression analysis to estimate the effect of age, sex and disease duration on GPi DBS outcomes. Results were summarised with mean change and 95% CI.ResultsDYT-TOR1A (68%, 38.4 points; p<0.001), DYT-THAP1 (37% 14.5 points; p<0.001) and NBIA/DYT-PANK2 (27%, 21.4 points; p<0.001) improved in BFMMS; only DYT-TOR1A improved in BFMDS (69%, 9.7 points; p<0.001). Improvement in DYT-TOR1A was significantly greater than in DYT-THAP1 (BFMMS −31%), NBIA/DYT-PANK2 (BFMMS −35%; BFMDS −53%) and CHOR/DYT-ADCY5 (BFMMS −36%; BFMDS −42%). Worse motor outcomes were associated with longer dystonia duration and older age at dystonia onset in DYT-TOR1A, longer dystonia duration in DYT/PARK-TAF1 and younger age at dystonia onset in DYT-SGCE.ConclusionsGPi DBS outcomes vary across monogenic dystonias. These data serve to inform patient selection and prognostic counselling.

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Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.769275 ◽

2021 ◽

Vol 12 ◽

Author(s):

Laura Wehmeyer ◽

Thomas Schüller ◽

Jana Kiess ◽

Petra Heiden ◽

Veerle Visser-Vandewalle ◽

...

Keyword(s):

Systematic Review ◽

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Rating Scale ◽

Meta Analysis ◽

Secondary Outcome ◽

Centromedian Nucleus ◽

Treatment Refractory ◽

Deep Brain

Background: Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). The four most commonly used DBS targets for TS include the centromedian nucleus–nucleus ventrooralis internus (CM-Voi) and the centromedian nucleus–parafascicular (CM-Pf) complexes of the thalamus, and the posteroventrolateral (pvIGPi) and the anteromedial portion of the globus pallidus internus (amGPi). Differences and commonalities between those targets need to be compared systematically.Objective: Therefore, we evaluated whether DBS is effective in reducing TS symptoms and target-specific differences.Methods: A PubMed literature search was conducted according to the PRISMA guidelines. Eligible literature was used to conduct a systematic review and meta-analysis.Results: In total, 65 studies with 376 patients were included. Overall, Yale Global Tic Severity Scale (YGTSS) scores were reduced by more than 50 in 69% of the patients. DBS also resulted in significant reductions of secondary outcome measures, including the total YGTSS, modified Rush Video-Based Tic Rating Scale (mRVRS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Becks Depression Inventory (BDI). All targets resulted in significant reductions of YGTSS scores and, with the exception of the CM-Pf, also in reduced YBOCS scores. Interestingly, DBS of pallidal targets showed increased YGTSS and YBOCS reductions compared to thalamic targets. Also, the meta-analysis including six randomized controlled and double-blinded trials demonstrated clinical efficacy of DBS for TS, that remained significant for GPi but not thalamic stimulation in two separate meta-analyses.Conclusion: We conclude that DBS is a clinically effective treatment option for patients with treatment-refractory TS, with all targets showing comparable improvement rates. Future research might focus on personalized and symptom-specific target selection.

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Deep brain stimulation for multiple sclerosis tremor: A systematic review and meta-analysis

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2021.103256 ◽

2021 ◽

Vol 56 ◽

pp. 103256

Author(s):

Alireza Zali ◽

Reza Jalili Khoshnood ◽

Mahsa Motavaf ◽

Alireza Salimi ◽

Meisam Akhlaghdoust ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Meta Analysis ◽

Deep Brain

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Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor

Neurology ◽

10.1212/wnl.0000000000008875 ◽

2020 ◽

Vol 94 (10) ◽

pp. e1073-e1084 ◽

Cited By ~ 6

Author(s):

Takashi Tsuboi ◽

Zakia Jabarkheel ◽

Pamela R. Zeilman ◽

Matthew J. Barabas ◽

Kelly D. Foote ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Rating Scale ◽

Statistical Significance ◽

Ventral Intermediate Nucleus ◽

Deep Brain

ObjectiveTo assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to compare with DBS outcomes in essential tremor (ET).MethodsWe retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2–3 years, 4–5 years, and ≥6 years after surgery.ResultsTwenty-six patients with DT and 97 patients with ET were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4–5 years (52.2%; p = 0.032) but this did not reach statistical significance at ≥6 years (46.0%, p = 0.063) in DT, which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2–3 years follow-up.ConclusionOverall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long term likely related to intervention at the final common node in the pathologic tremor network. However, the long-term ADL improvements in DT were not sustained, possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features.Classification of evidenceThis study provides Class IV evidence that VIM DBS improves tremor in patients with DT or ET.

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A systematic review and meta-analysis of deep brain stimulation for depression

Depression and Anxiety ◽

10.1002/da.22746 ◽

2018 ◽

Vol 35 (5) ◽

pp. 468-480 ◽

Cited By ~ 24

Author(s):

Steve Kisely ◽

Amy Li ◽

Nicola Warren ◽

Dan Siskind

Keyword(s):

Systematic Review ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Meta Analysis ◽

Deep Brain

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Faculty Opinions recommendation of Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726112604.793546319 ◽

2018 ◽

Author(s):

Luc Mallet

Keyword(s):

Systematic Review ◽

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Meta Analysis ◽

Deep Brain

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Use of Topical Vancomycin Powder to Reduce Surgical Site Infections after Deep Brain Stimulation Surgery: UCSF Experience and Meta-Analysis

Stereotactic and Functional Neurosurgery ◽

10.1159/000520197 ◽

2021 ◽

pp. 1-10

Author(s):

Sravani Kondapavulur ◽

John F. Burke ◽

Monica Volz ◽

Doris D. Wang ◽

Philip A. Starr

Keyword(s):

Systematic Review ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Odds Ratio ◽

Meta Analysis ◽

Control Group ◽

Inclusion Criteria ◽

Vancomycin Powder ◽

Group 3 ◽

Deep Brain

Objective: Surgical site infection (SSI) is the most common serious complication of deep brain stimulation (DBS) implantation surgery. Here, we report a single-surgeon experience on the efficacy of topical, intrawound vancomycin powder (VP) in reducing SSI for DBS surgery and present the first systematic review and meta-analysis examining the effect of topical vancomycin on SSI in patients after DBS surgery. Methods: For the retrospective review, all unique patients undergoing DBS surgery at UCSF for new hardware implantation or internal pulse generator (IPG) replacement by a single surgeon from September 2013 to March 2019, with at least 1 year of follow-up data, were included. For the meta-analysis, we included all primary studies that compared SSIs with and without application of topical vancomycin in DBS surgeries. Results: 368 unique patients met inclusion criteria; 195 patients received topical VP (VP group) and 173 did not (control). 99/195 patients in the VP group underwent new DBS implantation and 96/195 had IPG replacement. 71/173 patients in the control group had new DBS implantation and 102/173 had IPG replacement. There were 10 total cases of SSI: 4 patients from the VP group (3 new implants and 1 IPG replacement) and 6 patients from the control group (3 new implants and 3 IPG replacements), resulting in SSI rates of 2.1 and 3.5%, respectively (p value = 0.337). Including our retrospective analysis, 6 studies met inclusion criteria for the systematic review and meta-analysis. In the 4 studies that examined primary DBS implants, 479 total patients received topical VP and 436 did not; mean odds ratio for SSI with topical vancomycin was 0.802 (95% confidence interval [CI] 0.175–3.678). Across the 5 studies that examined IPG implantations or replacements, 606 total patients received topical VP while 1,173 patients did not; mean odds ratio for SSI with topical vancomycin was 0.492 (95% CI 0.164–1.475). In either case, topical VP application did not significantly decrease risk of SSI. Conclusion: Surgical infections after DBS surgery are uncommon events, with studies demonstrating mixed results on whether topical vancomycin reduces this risk. Our single-institution retrospective analysis and systematic review of prior studies both demonstrated no significant SSI rate reduction with topical VP. This is likely due to low baseline SSI rates, resulting in a small effect size for prevention. Given the cost-effectiveness, simplicity, and low risk, topical, intrawound VP remains a treatment option to further reduce risk of SSI, particularly in settings with higher baseline infection rates.

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