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. 2019 Aug 27:10:934.
doi: 10.3389/fneur.2019.00934. eCollection 2019.

Comparison Between Levodopa-Carbidopa Intestinal Gel Infusion and Subthalamic Nucleus Deep-Brain Stimulation for Advanced Parkinson's Disease: A Systematic Review and Meta-Analysis

Xiao Dong Liu  1 , Yi Bao  1 , Guang Jian Liu  1
Affiliations

Comparison Between Levodopa-Carbidopa Intestinal Gel Infusion and Subthalamic Nucleus Deep-Brain Stimulation for Advanced Parkinson's Disease: A Systematic Review and Meta-Analysis

Xiao Dong Liu et al. Front Neurol. .

Abstract

Background: Currently, some advanced treatments such as Levodopa-Carbidopa intestinal gel infusion (LCIG), deep-brain stimulation (DBS), and subcutaneous apomorphine infusion have become alternative strategies for advanced Parkinson's disease (PD). However, which treatment is better for individual patients remains unclear. This review aims to compare therapeutic effects of motor and/or non-motor symptoms of advanced PD patients between LCIG and DBS. Methods: We manually searched electronic databases (PubMed, Embase, Cochrane Library) and reference lists of included articles published until April 04, 2019 using related terms, without language restriction. We included case-controlled cohort studies and randomized-controlled trials, which directly compared differences between LCIG and DBS. The Newcastle-Ottawa scale (NOS), proposed by the Cochrane Collaboration, was utilized to assess the quality of the included studies. Two investigators independently extracted data from each trial. Pooled standard-mean differences (SMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated by meta-analysis. Outcomes were grouped according to the part III and part IV of the Unified Parkinson Disease Rating Scale (UPDRS) and adverse events. We also descriptively reviewed some data, which were unavailable for statistical analysis. Results: This review included five cohort trials of 257 patients for meta-analysis. There were no significant differences between LCIG and subthalamic nucleus deep-brain stimulation (STN-DBS) on UPDRS-III and adverse events comparisons: UPDRS-III (pooled SMDs = 0.200, 95% CI: -0.126-0.527, P = 0.230), total adverse events (pooled RRs = 1.279, 95% CI: 0.983-1.664, P = 0.067), serious adverse events (pooled RRs = 1.539, 95% CI: 0.664-3.566, P = 0.315). Notably, the improvement of UPDRS-IV was more significant in STN-DBS groups: pooled SMDs = 0.857, 95% CI: 0.130-1.584, P = 0.021. However, the heterogeneity was moderate for UPDRS-IV (I 2 = 73.8%). Conclusion: LCIG has comparable effects to STN-DBS on motor function for advanced PD, with acceptable tolerability. More large, well-designed trials are needed to assess the comparability of LCIG and STN-DBS in the future.

Keywords: Levodopa-Carbidopa intestinal gel infusion; Parkinson's disease; comparison; deep-brain stimulation; meta-analysis.

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Figures

Figure 1
Figure 1
Process of study selection.
Figure 2
Figure 2
Comparisons between LCIG and STN-DBS for UPDRS III, UPDRS IV. LCIG, Levodopa/carbidopa intestinal gel infusion; STN-DBS, Subthalamic nucleus deep brain stimulation; m, mean; sd, standard error.
Figure 3
Figure 3
Comparisons between LCIG and STN-DBS for adverse events. LCIG, Levodopa/carbidopa intestinal gel infusion; STN-DBS, Subthalamic nucleus deep brain stimulation.
See this image and copyright information in PMC

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References

    1. Olanow CW, Stocchi F. Levodopa: a new look at an old friend. Mov Disord. (2018) 33:859–66. 10.1002/mds.27216 - DOI - PubMed
    1. Espay AJ, Morgante F, Merola A, Fasano A, Marsili L, Fox SH, et al. . Levodopa-induced dyskinesia in Parkinson disease: current and evolving concepts. Ann Neurol. (2018) 84:797–811. 10.1002/ana.25364 - DOI - PubMed
    1. Tambasco N, Romoli M, Calabresi P. Levodopa in Parkinson's disease: current status and future developments. Curr Neuropharmacol. (2018) 16:1239–52. 10.2174/1570159X15666170510143821 - DOI - PMC - PubMed
    1. Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J, et al. . Parkinson disease. Nat Rev Dis Primers. (2017) 3:17013. 10.1038/nrdp.2017.13 - DOI - PubMed
    1. Rodriguez-Blazquez C, Forjaz MJ, Lizan L, Paz S, Martinez-Martin P. Estimating the direct and indirect costs associated with Parkinson's disease. Expert Rev Pharmacoecon Outcomes Res. (2015) 15:889–911. 10.1586/14737167.2015.1103184 - DOI - PubMed

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