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A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia.
J Neurol. 2020 May; 267(5):1278-1290.JN

Abstract

OBJECTIVE

To analyze deep brain stimulation (DBS) outcomes in patients with cervical dystonia (CD), the relationships between motor and disability/pain outcomes, and the differences in outcomes between globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS, and to identify potential outcome predictors.

METHODS

A systematic literature search identified individual patient data of CD patients who underwent DBS and whose outcomes were assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Then, we performed a pooled meta-analysis on this cohort.

RESULTS

A review of 39 papers yielded 208 patients with individual TWSTRS scores and demographic information. At a mean follow-up period of 23.3 months after either GPi or STN DBS, the TWSTRS total (58.8%), severity (53.9%), disability (61.3%), and pain (46.6%) scores significantly improved compared to baseline status (all p < 0.001). There were no significant outcome differences between short-term (< 23.3 months) and long-term (≥ 23.3 months). The TWSTRS outcomes after GPi and STN DBS were comparable, whereas these two targets showed different adverse effect profiles. The rates of responders to DBS according to the TWSTRS total and severity (defined as ≥ 25% improvement) were both 89%. Regression analyses demonstrated motor benefits associated with disability improvement more than pain relief (R2 = 0.345 and 0.195, respectively). No clinically meaningful predictors for DBS outcomes were identified.

CONCLUSION

DBS improves motor symptoms, disability, and pain in CD patients and may provide sustained benefits over 2 years. GPi and STN appear to be equally effective targets with different adverse effect profiles.

Authors+Show Affiliations

Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA. takashi80@gmail.com. Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan. takashi80@gmail.com.Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA.Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA.Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA.Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA.Department of Neurosurgery, University of Florida, Gainesville, FL, USA.Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA.Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31938862

Citation

Tsuboi, Takashi, et al. "A Pooled Meta-analysis of GPi and STN Deep Brain Stimulation Outcomes for Cervical Dystonia." Journal of Neurology, vol. 267, no. 5, 2020, pp. 1278-1290.
Tsuboi T, Wong JK, Almeida L, et al. A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia. J Neurol. 2020;267(5):1278-1290.
Tsuboi, T., Wong, J. K., Almeida, L., Hess, C. W., Wagle Shukla, A., Foote, K. D., Okun, M. S., & Ramirez-Zamora, A. (2020). A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia. Journal of Neurology, 267(5), 1278-1290. https://doi.org/10.1007/s00415-020-09703-9
Tsuboi T, et al. A Pooled Meta-analysis of GPi and STN Deep Brain Stimulation Outcomes for Cervical Dystonia. J Neurol. 2020;267(5):1278-1290. PubMed PMID: 31938862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia. AU - Tsuboi,Takashi, AU - Wong,Joshua K, AU - Almeida,Leonardo, AU - Hess,Christopher W, AU - Wagle Shukla,Aparna, AU - Foote,Kelly D, AU - Okun,Michael S, AU - Ramirez-Zamora,Adolfo, Y1 - 2020/01/14/ PY - 2019/11/05/received PY - 2020/01/09/accepted PY - 2020/01/07/revised PY - 2020/1/16/pubmed PY - 2020/1/16/medline PY - 2020/1/16/entrez KW - Cervical dystonia KW - Deep brain stimulation KW - Globus pallidus internus KW - Meta-analysis KW - Subthalamic nucleus SP - 1278 EP - 1290 JF - Journal of neurology JO - J. Neurol. VL - 267 IS - 5 N2 - OBJECTIVE: To analyze deep brain stimulation (DBS) outcomes in patients with cervical dystonia (CD), the relationships between motor and disability/pain outcomes, and the differences in outcomes between globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS, and to identify potential outcome predictors. METHODS: A systematic literature search identified individual patient data of CD patients who underwent DBS and whose outcomes were assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Then, we performed a pooled meta-analysis on this cohort. RESULTS: A review of 39 papers yielded 208 patients with individual TWSTRS scores and demographic information. At a mean follow-up period of 23.3 months after either GPi or STN DBS, the TWSTRS total (58.8%), severity (53.9%), disability (61.3%), and pain (46.6%) scores significantly improved compared to baseline status (all p < 0.001). There were no significant outcome differences between short-term (< 23.3 months) and long-term (≥ 23.3 months). The TWSTRS outcomes after GPi and STN DBS were comparable, whereas these two targets showed different adverse effect profiles. The rates of responders to DBS according to the TWSTRS total and severity (defined as ≥ 25% improvement) were both 89%. Regression analyses demonstrated motor benefits associated with disability improvement more than pain relief (R2 = 0.345 and 0.195, respectively). No clinically meaningful predictors for DBS outcomes were identified. CONCLUSION: DBS improves motor symptoms, disability, and pain in CD patients and may provide sustained benefits over 2 years. GPi and STN appear to be equally effective targets with different adverse effect profiles. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/31938862/A_pooled_meta_analysis_of_GPi_and_STN_deep_brain_stimulation_outcomes_for_cervical_dystonia_ L2 - https://dx.doi.org/10.1007/s00415-020-09703-9 DB - PRIME DP - Unbound Medicine ER -
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