Comparison of the Efficacy of Deep Brain Stimulation in Different Targets in Improving Gait in Parkinson's Disease: A Systematic Review and Bayesian Network Meta-Analysis

Background: Although a variety of targets for deep brain stimulation (DBS) have been found to be effective in Parkinson's disease (PD), it remains unclear which target for DBS leads to the best improvement in gait disorders in patients with PD. The purpose of this network meta-analysis (NMA) is to compare the efficacy of subthalamic nucleus (STN)-DBS, internal globus pallidus (GPi)-DBS, and pedunculopontine nucleus (PPN)-DBS, in improving gait disorders in patients with PD.Methods: We searched the PubMed database for articles published from January 1990 to December 2020. We used various languages to search for relevant documents to reduce language bias. A Bayesian NMA and systematic review of randomized and non-randomized controlled trials were conducted to explore the effects of different targets for DBS on gait damage.Result: In the 34 included studies, 538 patients with PD met the inclusion criteria. The NMA results of the effect of the DBS “on and off” on the mean change of the gait of the patients in medication-off show that GPi-DBS, STN-DBS, and PPN-DBS are significantly better than the baseline [GPi-DBS: –0.79(–1.2, –0.41), STN-DBS: –0.97(–1.1, –0.81), and PPN-DBS: –0.56(–1.1, –0.021)]. According to the surface under the cumulative ranking (SUCRA) score, the STN-DBS (SUCRA = 74.15%) ranked first, followed by the GPi-DBS (SUCRA = 48.30%), and the PPN-DBS (SUCRA = 27.20%) ranked last. The NMA results of the effect of the DBS “on and off” on the mean change of the gait of the patients in medication-on show that, compared with baseline, GPi-DBS and STN-DBS proved to be significantly effective [GPi-DBS: –0.53 (–1.0, –0.088) and STN-DBS: –0.47(–0.66, –0.29)]. The GPi-DBS ranked first (SUCRA = 59.00%), followed by STN-DBS(SUCRA = 51.70%), and PPN-DBS(SUCRA = 35.93%) ranked last.Conclusion: The meta-analysis results show that both the STN-DBS and GPi-DBS can affect certain aspects of PD gait disorder.

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Effects of pedunculopontine nucleus deep brain stimulation on gait disorders in Parkinson’s Disease: A meta-analysis of the literature

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.106108 ◽

2020 ◽

Vol 198 ◽

pp. 106108

Author(s):

Kaijia Yu ◽

Zhiwei Ren ◽

Song Guo ◽

Jianyu Li ◽

Yongjie Li

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Meta Analysis ◽

Pedunculopontine Nucleus ◽

Gait Disorders ◽

Deep Brain

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

Acta Médica Portuguesa ◽

10.20344/amp.4928 ◽

2014 ◽

Vol 27 (3) ◽

pp. 372 ◽

Cited By ~ 25

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

Introduction: 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. Material and Methods: 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. Results: 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%). Discussion: 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. Conclusion: 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. Keywords: Parkinson’s Disease; Deep Brain Stimulation; Anxiety; Depression; Meta-Analysis.

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

Parkinson s Disease ◽

10.1155/2018/9756468 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 6

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.

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Pedunculopontine Nucleus Deep Brain Stimulation Improves Gait Disorder in Parkinson’s Disease: A Systematic Review and Meta-analysis

Neurochemical Research ◽

10.1007/s11064-020-02962-y ◽

2020 ◽

Vol 45 (4) ◽

pp. 709-719

Author(s):

Fabin Lin ◽

Dihang Wu ◽

Chenxin Lin ◽

Huihui Cai ◽

Lina Chen ◽

...

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Meta Analysis ◽

Pedunculopontine Nucleus ◽

Gait Disorder ◽

Deep Brain

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Effect of deep brain stimulation on impulse control behaviors of Parkinson’s disease patients: A systematic review and meta-analysis

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101361 ◽

2021 ◽

Vol 26 ◽

pp. 101361

Author(s):

Ali Razmkon ◽

Saeed Abdollahifard ◽

Hirad Rezaei ◽

Amir Reza Bahadori ◽

Amirhossein Roshanshad ◽

...

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Impulse Control ◽

Meta Analysis ◽

Deep Brain

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

Basic and Clinical Neuroscience Journal ◽

10.32598/bcn.2021.3420.1 ◽

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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