Tags

Type your tag names separated by a space and hit enter

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease.
J Neurosurg. 2014 Sep; 121(3):709-18.JN

Abstract

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.

Authors+Show Affiliations

Department of Neurology, the Second Affiliated Hospital of Chong Qing Medical University, YuZhong, Chong Qing, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24905564

Citation

Liu, Yi, et al. "Meta-analysis Comparing Deep Brain Stimulation of the Globus Pallidus and Subthalamic Nucleus to Treat Advanced Parkinson Disease." Journal of Neurosurgery, vol. 121, no. 3, 2014, pp. 709-18.
Liu Y, Li W, Tan C, et al. Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. J Neurosurg. 2014;121(3):709-18.
Liu, Y., Li, W., Tan, C., Liu, X., Wang, X., Gui, Y., Qin, L., Deng, F., Hu, C., & Chen, L. (2014). Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. Journal of Neurosurgery, 121(3), 709-18. https://doi.org/10.3171/2014.4.JNS131711
Liu Y, et al. Meta-analysis Comparing Deep Brain Stimulation of the Globus Pallidus and Subthalamic Nucleus to Treat Advanced Parkinson Disease. J Neurosurg. 2014;121(3):709-18. PubMed PMID: 24905564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. AU - Liu,Yi, AU - Li,Weina, AU - Tan,Changhong, AU - Liu,Xi, AU - Wang,Xin, AU - Gui,Yuejiang, AU - Qin,Lu, AU - Deng,Fen, AU - Hu,Changlin, AU - Chen,Lifen, Y1 - 2014/06/06/ PY - 2014/6/7/entrez PY - 2014/6/7/pubmed PY - 2014/11/19/medline KW - ADLs = activities of daily living KW - BDI-II = Beck Depression Inventory, 2nd edition KW - DBS = deep brain stimulation KW - GPi = globus pallidus internus KW - LED = levodopa-equivalent dosage KW - MPTP = 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine KW - PD = Parkinson disease KW - Parkinson disease KW - RCT = randomized controlled trial KW - SMD = standardized mean difference KW - STN = subthalamic nucleus KW - UPDRS = Unified Parkinson's Disease Rating Scale KW - UPDRSII, -III = UPDRS Sections II (ADLs) and III (motor section) KW - Unified Parkinson's Disease Rating Scale KW - deep brain stimulation KW - functional neurosurgery KW - globus pallidus KW - subthalamic nucleus SP - 709 EP - 18 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 121 IS - 3 N2 - 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. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/24905564/Meta_analysis_comparing_deep_brain_stimulation_of_the_globus_pallidus_and_subthalamic_nucleus_to_treat_advanced_Parkinson_disease_ L2 - https://thejns.org/doi/10.3171/2014.4.JNS131711 DB - PRIME DP - Unbound Medicine ER -