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Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson's disease: A systematic review.
J Int Med Res. 2017 Oct; 45(5):1602-1612.JI

Abstract

Objective Deep brain stimulation (DBS) for treatment of advanced Parkinson's disease (PD) has two anatomical targets: the subthalamic nucleus (STN) and the globus pallidus internus (GPI). The clinical effectiveness of these two stimulation targets was compared in the present study. Methods A systematic review and meta-analysis was performed to evaluated the postoperative changes in the United Parkinson's Disease Rating Scale (UPDRS) on- and off-phase, on-stimulation motor scores; activities of daily living score (ADLS); and levodopa equivalent dose (LED) after STN and GPI stimulation. Randomized and nonrandomized controlled trials of PD treated by STN and GPI stimulation were considered for inclusion. Results Eight published reports of eligible studies involving 599 patients met the inclusion criteria. No significant differences were observed between the STN and GPI groups in the on-medication, on-stimulation UPDRS motor score [mean difference, 2.15; 95% confidence interval (CI), -0.96-5.27] or ADLS (mean difference, 3.40; 95% CI, 0.95-7.76). Significant differences in favor of STN stimulation were noted in the off-medication, on-stimulation UPDRS motor score (mean difference, 1.67; 95% CI, 0.98-2.37) and LED (mean difference, 130.24; 95% CI, 28.82-231.65). Conclusion The STN may be the preferred target for DBS in consideration of medication reduction, economic efficiency, and motor function improvement in the off phase. However, treatment decisions should be made according to the individual patient's symptoms and expectations.

Authors+Show Affiliations

1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China. 2 Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.3 Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China. 4 Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.4 Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.5 Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28701061

Citation

Xu, Hao, et al. "Subthalamic Nucleus and Globus Pallidus Internus Stimulation for the Treatment of Parkinson's Disease: a Systematic Review." The Journal of International Medical Research, vol. 45, no. 5, 2017, pp. 1602-1612.
Xu H, Zheng F, Krischek B, et al. Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson's disease: A systematic review. J Int Med Res. 2017;45(5):1602-1612.
Xu, H., Zheng, F., Krischek, B., Ding, W., Xiong, C., Wang, X., & Niu, C. (2017). Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson's disease: A systematic review. The Journal of International Medical Research, 45(5), 1602-1612. https://doi.org/10.1177/0300060517708102
Xu H, et al. Subthalamic Nucleus and Globus Pallidus Internus Stimulation for the Treatment of Parkinson's Disease: a Systematic Review. J Int Med Res. 2017;45(5):1602-1612. PubMed PMID: 28701061.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson's disease: A systematic review. AU - Xu,Hao, AU - Zheng,Feng, AU - Krischek,Boris, AU - Ding,Wanhai, AU - Xiong,Chi, AU - Wang,Xin, AU - Niu,Chaoshi, Y1 - 2017/07/12/ PY - 2017/7/14/pubmed PY - 2018/5/29/medline PY - 2017/7/14/entrez KW - Parkinson’s disease KW - Subthalamic nucleus KW - deep brain stimulation KW - globus pallidus internus SP - 1602 EP - 1612 JF - The Journal of international medical research JO - J Int Med Res VL - 45 IS - 5 N2 - Objective Deep brain stimulation (DBS) for treatment of advanced Parkinson's disease (PD) has two anatomical targets: the subthalamic nucleus (STN) and the globus pallidus internus (GPI). The clinical effectiveness of these two stimulation targets was compared in the present study. Methods A systematic review and meta-analysis was performed to evaluated the postoperative changes in the United Parkinson's Disease Rating Scale (UPDRS) on- and off-phase, on-stimulation motor scores; activities of daily living score (ADLS); and levodopa equivalent dose (LED) after STN and GPI stimulation. Randomized and nonrandomized controlled trials of PD treated by STN and GPI stimulation were considered for inclusion. Results Eight published reports of eligible studies involving 599 patients met the inclusion criteria. No significant differences were observed between the STN and GPI groups in the on-medication, on-stimulation UPDRS motor score [mean difference, 2.15; 95% confidence interval (CI), -0.96-5.27] or ADLS (mean difference, 3.40; 95% CI, 0.95-7.76). Significant differences in favor of STN stimulation were noted in the off-medication, on-stimulation UPDRS motor score (mean difference, 1.67; 95% CI, 0.98-2.37) and LED (mean difference, 130.24; 95% CI, 28.82-231.65). Conclusion The STN may be the preferred target for DBS in consideration of medication reduction, economic efficiency, and motor function improvement in the off phase. However, treatment decisions should be made according to the individual patient's symptoms and expectations. SN - 1473-2300 UR - https://www.unboundmedicine.com/medline/citation/28701061/Subthalamic_nucleus_and_globus_pallidus_internus_stimulation_for_the_treatment_of_Parkinson's_disease:_A_systematic_review_ L2 - https://journals.sagepub.com/doi/10.1177/0300060517708102?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -