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Review
. 2018 Aug;97(35):e12153.
doi: 10.1097/MD.0000000000012153.

The long-term efficacy of STN vs GPi deep brain stimulation for Parkinson disease: A meta-analysis

Lilei Peng  1 , Jie Fu, Yang Ming, Shan Zeng, Haiping He, Ligang Chen
Affiliations
Review

The long-term efficacy of STN vs GPi deep brain stimulation for Parkinson disease: A meta-analysis

Lilei Peng et al. Medicine (Baltimore). 2018 Aug.

Abstract

Objective: This meta-analysis assessed the long-term efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus interna (GPi) for Parkinson disease (PD).

Methods: PubMed, Cochrane Library, and Clinical Trials databases were searched. Outcomes were unified Parkinson disease rating scale section (UPDRS) III off-medication score, Parkinson's disease questionnaire: 39 activities of daily living (PDQ-39 ADL) score, and levodopa-equivalent dosage after DBS.

Results: During the off-medication state, pooled weighted mean difference (WMD) of UPDRS III score was .69 (95% confidence interval [CI] = -1.77 to 3.16, P = .58). In subgroup analysis, WMD of UPDRS III off-medication scores from baseline to 2 years and 3 years post-DBS were -.61 (95% CI = -2.97 to 1.75, P = .61) and 2.59 (95% CI = -2.30 to 7.47, P = .30). Pooled WMD of changes in tremor, rigidity, and gait scores were 1.12 (95% CI = -0.05 to 2.28, P = .06), 1.22 (95% CI = -0.51 to 2.94, P = .17) and .37 (95% CI = -0.13 to 0.87, P = .15), respectively. After DBS, pooled WMD of PDQ-39 ADL and LED were -3.36 (95% CI = -6.36 to -0.36, P = .03) and 194.89 (95% CI = 113.16 to 276.63, P < .001).

Conclusions: STN-DBS and GPi-DBS improve motor function and activities of daily living for PD. Differences in the long-term efficacy for PD on motor symptoms were not observed.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Search flow for the trial identification and selection process.
Figure 2
Figure 2
Forest plot: WMD in UPDRS III score of five studies; off-medication change and 95% CI. CI = confidence interval, GPi = globus pallidus pars interna, STN = subthalamic nucleus, UPDRS = Unified Parkinson's Disease Rating Scale, WMD = weighted mean difference.
Figure 3
Figure 3
Forest plot: WMD in UPDRS III scores from baseline to 2 years and 3 years post-DBS; off-medication change and 95% CI. Two years post-DBS. CI = confidence interval, DBS = deep brain stimulation, GPi = globus pallidus pars interna, STN = subthalamic nucleus, UPDRS = Unified Parkinson's Disease Rating Scale, WMD = weighted mean difference.
Figure 4
Figure 4
Forest plot: WMD in UPDRS III score on motor subtypes; off-medication change and 95% CI. CI = confidence interval, GPi = globus pallidus pars interna, STN = subthalamic nucleus, UPDRS = Unified Parkinson's Disease Rating Scale, WMD = weighted mean difference.
Figure 5
Figure 5
Forest plot: WMD in PDQ-39 ADL change and 95% CI. CI = confidence interval, GPi = globus pallidus pars interna, PDQ-39 ADL = Parkinson disease questionnaire: 39 activities of daily living, STN = subthalamic nucleus, WMD = weighted mean difference.
Figure 6
Figure 6
Forest plot: WMD in LED change and 95% CI. CI = confidence interval, GPi = globus pallidus pars interna, LED =  levodopa-equivalent dosage, STN = subthalamic nucleus, WMD = weighted mean difference.
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