Deep brain stimulation for Parkinson's disease-related postural abnormalities: a systematic review and meta-analysis

Abstract

Deep brain stimulation (DBS) has become a well-established treatment modality for Parkinson's disease (PD), especially regarding motor fluctuations, dyskinesias, and tremor. Although postural abnormalities (i.e., Camptocormia [CC] and Pisa syndrome [Pisa]) are known to be a major symptom of PD as well, the influence of DBS on postural abnormalities is unclear. The objective of this study is to analyze the existing literature regarding DBS for PD-associated postural abnormalities in a systematic review and meta-analysis. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of 18 studies that reported the effect of DBS regarding postural abnormalities. After screening of 53 studies, a total of 98 patients (44 female, 53 males, 1 not reported; mean age: 62.3, range 30-83 years) with postural abnormalities (CC n = 98; Pisa n = 11) were analyzed from 18 included studies. Of those patients, 94.9% underwent STN-DBS and 5.1% had GPi as DBS target area. A positive outcome was reported for 67.8% with CC and 72.2% with Pisa. In the meta-analysis, younger age and lower pre-operative UPDRS-III (ON/OFF) were found as positive predictive factors for a positive effect of DBS. DBS might be a potentially effective treatment option for PD-associated postural abnormalities. However, the level of evidence is rather low, and definition of postoperative outcome is heterogenous between studies. Therefore larger, prospective trials are necessary to give a clear recommendation.

Keywords: Deep brain stimulation; Neurosurgery; Parkinson’s disease; Posture; Spine.

Fig. 1

PRISM flowchart of the study selection process

Fig. 2

Proportions of effective, partially effective, or non-effective outcome after DBS with respect to postural abnormalities (i.e., Pisa syndrome and Camptocormia)

Fig. 3

Meta-analysis of predictive parameters for positive outcome (i.e., absolute TLA < 30° or relative TLA improvement > 50%). A Mean (± SD) of patient age with respect to absolute TLA after DBS. B Mean (± SD) of patient age with respect to relative TLA reduction after DBS. C Pre-OP UPDRS (ON) with respect to absolute TLA after DBS. D Pre-OP UPDRS (OFF) with respect to absolute TLA after DBS