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Review
. 2023 Aug 26;15(8):e44177.
doi: 10.7759/cureus.44177. eCollection 2023 Aug.

The Effects of Deep Brain Stimulation on Mood and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis

Nour El Ghazal  1   2 , Hayato Nakanishi  1   2 , Alfonso E Martinez-Nunez  3 , Nader K Al Sabbakh  1   2 , Omotayo A Segun-Omosehin  1   2 , Natalie E Bourdakos  1   2 , Maya Nasser  1   2 , Reem H Matar  1   2   4 , Christian Than  1   2   5 , Omar A Danoun  3 , Andrew Johnson  6
Affiliations
Review

The Effects of Deep Brain Stimulation on Mood and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis

Nour El Ghazal et al. Cureus. .

Abstract

Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the difference between subthalamic (STN) and globus pallidus internus (GPi) DBS on mood and quality of life with reference to minimal clinically important differences (MCID). A systematic literature search for articles published until November 2022 yielded 14 studies meeting the eligibility criteria, with a total of 1,088 patients undergoing STN (n=571) or GPi (n=517) stimulation. Baseline patient and clinical characteristics were comparable between the two groups. Results showed that GPi stimulation demonstrated a greater reduction in the Beck depression inventory (mean difference (MD)=1.68) than STN stimulation (MD=0.84). Hospital anxiety and depression scale showed a 2.69- and 3.48-point decrease by the GPi group in the depression and anxiety categories, respectively. The summary index (SI) of the PD questionnaire depicted a greater improvement in the GPi group from baseline (mean=41.01, 95% CI 34.89, 47.13) to follow-up (mean=30.85, 95% CI 22.08, 39.63) when compared to the STN group (baseline mean=42.43, 95% CI 34.50, 50.37; follow-up mean=34.21, 95% CI 25.43, 42.99). The emotions category also demonstrated a similar trend. However, STN stimulation showed greater reductions in motor symptoms and medication than GPi stimulation. This meta-analysis demonstrated that GPi stimulation seems to offer an advantage over STN stimulation in improving mood and quality of life in PD, but those effects must be further validated by larger studies.

Keywords: deep brain stimulation; globus pallidus internus; non-motor symptoms; parkinson's disease; subthalamic nucleus.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Pooled data of baseline characteristics between the STN and GPi groups. A. Age (years), B. Number of males (n)
GPi: globus pallidus internus, STN: subthalamic nucleus
Figure 3
Figure 3. Pooled data of the clinical characteristics between the STN and GPi groups. A. Duration of disease (years), B. Severity of disease (Hoehn-Yahr stage), C. Baseline UPDRS-III on and off medication
GPi: globus pallidus internus, STN: subthalamic nucleus, UPDRS: unified Parkinson's disease rating scale
Figure 4
Figure 4. Pooled estimate of BDI outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1) and six-month follow-up (A.2, B.2)
BDI: Beck depression inventory, GPi: globus pallidus internus, STN: subthalamic nucleus
Figure 5
Figure 5. Pooled estimate of HADS depression outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1) and 12-month follow-up (A.2, B.2)
GPi: globus pallidus internus, HADS: hospital anxiety and depression scale, STN: subthalamic nucleus
Figure 6
Figure 6. Pooled estimate of HADS anxiety outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1) and 12-month follow-up (A.2, B.2)
GPi: globus pallidus internus, HADS: hospital anxiety and depression scale, STN: subthalamic nucleus
Figure 7
Figure 7. Pooled estimate of UDPRS-I outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1) and six-month follow-up (A.2, B.2)
GPi: globus pallidus internus, STN: subthalamic nucleus, UPDRS: unified Parkinson's disease rating scale
Figure 8
Figure 8. Pooled estimate of PDQ-SI outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1) and six-month follow-up (A.2, B.2)
GPi: globus pallidus internus, PDQ-SI: Parkinson's disease questionnaire - summary index, STN: subthalamic nucleus
Figure 9
Figure 9. Pooled estimate of PDQ emotions outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1) and six-month follow-up (A.2, B.2)
GPi: globus pallidus internus, PDQ: Parkinson's disease questionnaire, STN: subthalamic nucleus
Figure 10
Figure 10. Pooled estimate of UDPRS-III off medication/off stimulation outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1), 6-12-month (A.2, B.2), and >24-month (A.3, B.3) follow-up
GPi: globus pallidus internus, STN: subthalamic nucleus, UPDRS: unified Parkinson's disease rating scale
Figure 11
Figure 11. Pooled estimate of UDPRS-III off-medication/on-stimulation outcomes in the STN group at baseline (A.1), 6-12-month (A.2), 12-24-month (A.3), and >24-month (A.4) follow-up
STN: subthalamic nucleus, UPDRS: unified Parkinson's disease rating scale
Figure 12
Figure 12. Pooled estimate of UDPRS-III off-medication/on-stimulation outcomes in the GPi group at baseline (B.1), 6-12-month (B.2), 12-24-month (B.3), and >24-month (B.4) follow-up
GPi: globus pallidus internus, UPDRS: unified Parkinson's disease rating scale
Figure 13
Figure 13. Pooled estimate of UDPRS-III on-medication/on-stimulation outcomes in the STN group at baseline (A.1), 6-12-month (A.2), 12-24-month (A.3), and >24-month (A.4) follow-up
STN: subthalamic nucleus, UPDRS: unified Parkinson's disease rating scale
Figure 14
Figure 14. Pooled estimate of UDPRS-III on-medication/on-stimulation outcomes in the GPi group at baseline (B.1), 6-12-month (B.2), 12-24-month (B.3), and >24-month (B.4) follow-up
GPi: globus pallidus internus, UPDRS: unified Parkinson's disease rating scale
Figure 15
Figure 15. Pooled estimate of LEDD medication (mg) outcomes between STN (A) and GPi (B) groups at baseline (A.1, B.1), 6-month (A.2, B.2), and 12-month (A.3, B.3) follow-up
GPi: globus pallidus internus, LEDD: levodopa equivalent daily dose, STN: subthalamic nucleus
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References

    1. Global, regional, and national burden of Parkinson's disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Dorsey ER, Elbaz A, Nichols E, et al. Lancet Neurol. 2018;17:939–953. - PMC - PubMed
    1. Non-motor features of Parkinson disease. Schapira AH, Chaudhuri KR, Jenner P. Nat Rev Neurosci. 2017;18:435–450. - PubMed
    1. Zahoor I, Shafi A, Haq E. Parkinson’s Disease: Pathogenesis and Clinical Aspects. Brisbane: Codon Publications; 2018. Pharmacological treatment of Parkinson’s disease. - PubMed
    1. Deep brain stimulation creates informational lesion through membrane depolarization in mouse hippocampus. Lowet E, Kondabolu K, Zhou S, Mount RA, Wang Y, Ravasio CR, Han X. Nat Commun. 2022;13:7709. - PMC - PubMed
    1. The role of deep brain stimulation in Parkinson's disease: an overview and update on new developments. Fang JY, Tolleson C. Neuropsychiatr Dis Treat. 2017;13:723–732. - PMC - PubMed

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