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. 2019 Feb 25:10:151.
doi: 10.3389/fneur.2019.00151. eCollection 2019.

Improvement of Deep Brain Stimulation in Dyskinesia in Parkinson's Disease: A Meta-Analysis

Yun Liu  1 , Feng Li  1 , Hansheng Luo  1 , Qiuguang He  1 , Lifen Chen  2 , Yuan Cheng  1 , Wenbin Zhang  3 , Zongyi Xie  1
Affiliations

Improvement of Deep Brain Stimulation in Dyskinesia in Parkinson's Disease: A Meta-Analysis

Yun Liu et al. Front Neurol. .

Abstract

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) have been proven to be equally effective in improving motor-symptoms for advanced Parkinson's disease (PD) patients. However, it is unclear that which target stimulation is more effective in reducing dyskinesia. We conducted the meta-analysis to evaluate the efficacy of STN and GPi-DBS in the dyskinesia. Methods: A systematic search was performed in PubMed, Embase, and the Cochrane Library databases. Controlled trials about the dyskinesia comparing the efficacy of GPi and STN DBS were included. Clinical data of dyskinesia and levodopa equivalent doses (LED) were collected for the meta-analysis. Results: Eight eligible trials containing a total of 822 patients were included in this meta-analysis. Our results showed that GPi DBS offered a greater reduction of dyskinesia than STN DBS at 12 months after surgery, with an overall pooled SMD of 0.32 (95% CI = 0.06 to 0.59, P = 0.02). Treatment of STN DBS was associated with a greater reduction of LED compared with GPi DBS, with a change score of -320.55 (95% CI = -401.36 to -239.73, P < 0.00001). Conclusion: GPi DBS is superior to reduce dyskinesia than STN DBS at 12 months after surgery for advanced PD patients. Further studies should focus on the different mechanism for dyskinesia reduction by GPi or STN DBS.

Keywords: Parkinson's disease; deep brain stimulation; dyskinesia; globus pallidus interna; subthalamic nucleus.

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Figures

Figure 1
Figure 1
Flow diagram of selection of studies. Among 157 articles screened, 5 randomized controlled studies and 3 non-randomized controlled trials were included in our meta-analysis.
Figure 2
Figure 2
Quality assessment of RCTs using Cochrane collaboration's tool for assessing risk of bias.
Figure 3
Figure 3
Forest plot of mean difference of dyskinesia score in the on-medication/on-stimulation state between STN DBS and GPi DBS. GPi, globus pallidus interna; STN, subthalamic nucleus; IV, inverse variance; CI, confidence interval; Std, standardized.
Figure 4
Figure 4
Forest plot: subgroup analyses were conducted according to follow-up periods in dyskinesia score between STN DBS and GPi DBS. GPi, globus pallidus interna; STN, subthalamic nucleus; IV, inverse variance; CI, confidence interval; Std, standardized.
Figure 5
Figure 5
Forest plot of standardized mean difference of levodopa equivalent doses between STN DBS and GPi DBS. GPi, globus pallidus interna; STN, subthalamic nucleus; IV, inverse variance; CI, confidence interval.
Figure 6
Figure 6
Forest plot: sensitivity analysis. GPi, globus pallidus interna; STN, subthalamic nucleus; IV, inverse variance; CI, confidence interval.
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