Deep brain stimulation for Parkinson's disease: Meta-analysis of results of randomized trials at varying lengths of follow-up

Seyed Alireza Mansouri, Shervin Taslimi, Jetan H. Badhiwala, Christopher D. Witiw, Farshad Nassiri, Vincent J.J. Odekerken, Rob M.A. De Bie, Suneil K. Kalia, Mojgan Hodaie, Renato P. Munhoz, Alfonso Fasano, Andres M. Lozano

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVE Deep brain stimulation (DBS) is effective in the management of patients with advanced Parkinson's disease (PD). While both the globus pallidus pars interna (GPi) and the subthalamic nucleus (STN) are accepted targets, their relative efficacy in randomized controlled trials (RCTs) has not been established beyond 12 months. The objective of this study was to conduct a meta-analysis of RCTs to compare outcomes among adults with PD undergoing DBS of GPi or STN at various time points, including 36 months of follow-up. METHODS The MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases were searched. Registries for clinical trials, selected conference proceedings, and the table of contents for selected journals were also searched. Screens were conducted independently and in duplicate. Among the 623 studies initially identified (615 through database search, 7 through manual review of bibliographies, and 1 through a repeat screen of literature prior to submission), 19 underwent full-text review; 13 of these were included in the quantitative meta-analysis. Data were extracted independently and in duplicate. The Cochrane Collaboration tool was used to assess the risk of bias. The GRADE evidence profile tool was used to assess the quality of the evidence. Motor scores, medication dosage reduction, activities of daily living, depression, dyskinesias, and adverse events were compared. The influence of disease duration (a priori) and the proportion of male patients within a study (post hoc) were explored as potential subgroups. RESULTS Thirteen studies (6 original cohorts) were identified. No difference in motor scores or activities of daily living was identified at 36 months. Medications were significantly reduced with STN stimulation (5 studies, weighted mean difference [WMD] -365.46, 95% CI -599.48 to -131.44, p = 0.002). Beck Depression Inventory scores were significantly better with GPi stimulation (3 studies; WMD 2.53, 95% CI 0.99-4.06 p = 0.001). The motor benefits of GPi and STN DBS for PD are similar. CONCLUSIONS The motor benefits achieved with GPi and STN DBS for PD are similar. DBS of STN allows for a greater reduction of medication, but not as significant an advantage as DBS of GPi with respect to mood. This difference is sustained at 36 months. Further long-term studies are necessary.

Original languageEnglish (US)
Pages (from-to)1199-1213
Number of pages15
JournalJournal of neurosurgery
Volume128
Issue number4
DOIs
StatePublished - Apr 2018

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Subthalamic Nucleus
Globus Pallidus
Deep Brain Stimulation
Parkinson Disease
Meta-Analysis
Activities of Daily Living
Randomized Controlled Trials
Databases
Depression
Dyskinesias
Bibliography
MEDLINE
Registries
Clinical Trials
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Mansouri, Seyed Alireza ; Taslimi, Shervin ; Badhiwala, Jetan H. ; Witiw, Christopher D. ; Nassiri, Farshad ; Odekerken, Vincent J.J. ; De Bie, Rob M.A. ; Kalia, Suneil K. ; Hodaie, Mojgan ; Munhoz, Renato P. ; Fasano, Alfonso ; Lozano, Andres M. / Deep brain stimulation for Parkinson's disease : Meta-analysis of results of randomized trials at varying lengths of follow-up. In: Journal of neurosurgery. 2018 ; Vol. 128, No. 4. pp. 1199-1213.
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abstract = "OBJECTIVE Deep brain stimulation (DBS) is effective in the management of patients with advanced Parkinson's disease (PD). While both the globus pallidus pars interna (GPi) and the subthalamic nucleus (STN) are accepted targets, their relative efficacy in randomized controlled trials (RCTs) has not been established beyond 12 months. The objective of this study was to conduct a meta-analysis of RCTs to compare outcomes among adults with PD undergoing DBS of GPi or STN at various time points, including 36 months of follow-up. METHODS The MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases were searched. Registries for clinical trials, selected conference proceedings, and the table of contents for selected journals were also searched. Screens were conducted independently and in duplicate. Among the 623 studies initially identified (615 through database search, 7 through manual review of bibliographies, and 1 through a repeat screen of literature prior to submission), 19 underwent full-text review; 13 of these were included in the quantitative meta-analysis. Data were extracted independently and in duplicate. The Cochrane Collaboration tool was used to assess the risk of bias. The GRADE evidence profile tool was used to assess the quality of the evidence. Motor scores, medication dosage reduction, activities of daily living, depression, dyskinesias, and adverse events were compared. The influence of disease duration (a priori) and the proportion of male patients within a study (post hoc) were explored as potential subgroups. RESULTS Thirteen studies (6 original cohorts) were identified. No difference in motor scores or activities of daily living was identified at 36 months. Medications were significantly reduced with STN stimulation (5 studies, weighted mean difference [WMD] -365.46, 95{\%} CI -599.48 to -131.44, p = 0.002). Beck Depression Inventory scores were significantly better with GPi stimulation (3 studies; WMD 2.53, 95{\%} CI 0.99-4.06 p = 0.001). The motor benefits of GPi and STN DBS for PD are similar. CONCLUSIONS The motor benefits achieved with GPi and STN DBS for PD are similar. DBS of STN allows for a greater reduction of medication, but not as significant an advantage as DBS of GPi with respect to mood. This difference is sustained at 36 months. Further long-term studies are necessary.",
author = "Mansouri, {Seyed Alireza} and Shervin Taslimi and Badhiwala, {Jetan H.} and Witiw, {Christopher D.} and Farshad Nassiri and Odekerken, {Vincent J.J.} and {De Bie}, {Rob M.A.} and Kalia, {Suneil K.} and Mojgan Hodaie and Munhoz, {Renato P.} and Alfonso Fasano and Lozano, {Andres M.}",
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Mansouri, SA, Taslimi, S, Badhiwala, JH, Witiw, CD, Nassiri, F, Odekerken, VJJ, De Bie, RMA, Kalia, SK, Hodaie, M, Munhoz, RP, Fasano, A & Lozano, AM 2018, 'Deep brain stimulation for Parkinson's disease: Meta-analysis of results of randomized trials at varying lengths of follow-up', Journal of neurosurgery, vol. 128, no. 4, pp. 1199-1213. https://doi.org/10.3171/2016.11.JNS16715

Deep brain stimulation for Parkinson's disease : Meta-analysis of results of randomized trials at varying lengths of follow-up. / Mansouri, Seyed Alireza; Taslimi, Shervin; Badhiwala, Jetan H.; Witiw, Christopher D.; Nassiri, Farshad; Odekerken, Vincent J.J.; De Bie, Rob M.A.; Kalia, Suneil K.; Hodaie, Mojgan; Munhoz, Renato P.; Fasano, Alfonso; Lozano, Andres M.

In: Journal of neurosurgery, Vol. 128, No. 4, 04.2018, p. 1199-1213.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Deep brain stimulation for Parkinson's disease

T2 - Meta-analysis of results of randomized trials at varying lengths of follow-up

AU - Mansouri, Seyed Alireza

AU - Taslimi, Shervin

AU - Badhiwala, Jetan H.

AU - Witiw, Christopher D.

AU - Nassiri, Farshad

AU - Odekerken, Vincent J.J.

AU - De Bie, Rob M.A.

AU - Kalia, Suneil K.

AU - Hodaie, Mojgan

AU - Munhoz, Renato P.

AU - Fasano, Alfonso

AU - Lozano, Andres M.

PY - 2018/4

Y1 - 2018/4

N2 - OBJECTIVE Deep brain stimulation (DBS) is effective in the management of patients with advanced Parkinson's disease (PD). While both the globus pallidus pars interna (GPi) and the subthalamic nucleus (STN) are accepted targets, their relative efficacy in randomized controlled trials (RCTs) has not been established beyond 12 months. The objective of this study was to conduct a meta-analysis of RCTs to compare outcomes among adults with PD undergoing DBS of GPi or STN at various time points, including 36 months of follow-up. METHODS The MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases were searched. Registries for clinical trials, selected conference proceedings, and the table of contents for selected journals were also searched. Screens were conducted independently and in duplicate. Among the 623 studies initially identified (615 through database search, 7 through manual review of bibliographies, and 1 through a repeat screen of literature prior to submission), 19 underwent full-text review; 13 of these were included in the quantitative meta-analysis. Data were extracted independently and in duplicate. The Cochrane Collaboration tool was used to assess the risk of bias. The GRADE evidence profile tool was used to assess the quality of the evidence. Motor scores, medication dosage reduction, activities of daily living, depression, dyskinesias, and adverse events were compared. The influence of disease duration (a priori) and the proportion of male patients within a study (post hoc) were explored as potential subgroups. RESULTS Thirteen studies (6 original cohorts) were identified. No difference in motor scores or activities of daily living was identified at 36 months. Medications were significantly reduced with STN stimulation (5 studies, weighted mean difference [WMD] -365.46, 95% CI -599.48 to -131.44, p = 0.002). Beck Depression Inventory scores were significantly better with GPi stimulation (3 studies; WMD 2.53, 95% CI 0.99-4.06 p = 0.001). The motor benefits of GPi and STN DBS for PD are similar. CONCLUSIONS The motor benefits achieved with GPi and STN DBS for PD are similar. DBS of STN allows for a greater reduction of medication, but not as significant an advantage as DBS of GPi with respect to mood. This difference is sustained at 36 months. Further long-term studies are necessary.

AB - OBJECTIVE Deep brain stimulation (DBS) is effective in the management of patients with advanced Parkinson's disease (PD). While both the globus pallidus pars interna (GPi) and the subthalamic nucleus (STN) are accepted targets, their relative efficacy in randomized controlled trials (RCTs) has not been established beyond 12 months. The objective of this study was to conduct a meta-analysis of RCTs to compare outcomes among adults with PD undergoing DBS of GPi or STN at various time points, including 36 months of follow-up. METHODS The MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases were searched. Registries for clinical trials, selected conference proceedings, and the table of contents for selected journals were also searched. Screens were conducted independently and in duplicate. Among the 623 studies initially identified (615 through database search, 7 through manual review of bibliographies, and 1 through a repeat screen of literature prior to submission), 19 underwent full-text review; 13 of these were included in the quantitative meta-analysis. Data were extracted independently and in duplicate. The Cochrane Collaboration tool was used to assess the risk of bias. The GRADE evidence profile tool was used to assess the quality of the evidence. Motor scores, medication dosage reduction, activities of daily living, depression, dyskinesias, and adverse events were compared. The influence of disease duration (a priori) and the proportion of male patients within a study (post hoc) were explored as potential subgroups. RESULTS Thirteen studies (6 original cohorts) were identified. No difference in motor scores or activities of daily living was identified at 36 months. Medications were significantly reduced with STN stimulation (5 studies, weighted mean difference [WMD] -365.46, 95% CI -599.48 to -131.44, p = 0.002). Beck Depression Inventory scores were significantly better with GPi stimulation (3 studies; WMD 2.53, 95% CI 0.99-4.06 p = 0.001). The motor benefits of GPi and STN DBS for PD are similar. CONCLUSIONS The motor benefits achieved with GPi and STN DBS for PD are similar. DBS of STN allows for a greater reduction of medication, but not as significant an advantage as DBS of GPi with respect to mood. This difference is sustained at 36 months. Further long-term studies are necessary.

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