Metabolic effects of deep brain stimulation in Parkinson's disease - a systematic review and meta-analysis

Abstract

Introduction: Deep brain stimulation (DBS) is an effective therapy for patients with advanced Parkinson's Disease (PD). The significant improvement in motor symptoms is undeniable. However, adverse events from the procedure can also occur.

Clinical rationale for study: Several sources have confirmed metabolic changes after a DBS procedure. However, there is no summary of the current state of knowledge about the impact of DBS on metabolic parameters changes expressed in weight gain in PD individuals, something which could guide further research.

Material and methods: We conducted a systematic review following PRISMA recommendations on articles evaluating a gain of weight and/or body mass index (BMI) after subthalamic nucleus (STN) DBS, globus pallidus internus (GPi) DBS, and ventral intermediate nucleus of the thalamus (VIM) DBS in patients with PD. Four databases were searched by two independent authors according to the established criteria. The collected data involved body mass, BMI or changes in these parameters before DBS and after the procedure, mean age of patients, disease duration, gender, L-dopa equivalent daily dose, and the Unified Parkinson's Disease Rating Scale part III.

Results: Of 1,290 articles found, 30 were evaluated as eligible and were included in the analysis. The study sample size ranged from 10 to 124 patients (mean, 32.6 ± 23.5, N = 1,110). The mean age across studies was 59.8 ± 7.5 (range 51.8 - 66, N = 636) years with mean value of the last follow-up point 13.6 ± 8.9 (range 1-38) months. A meta-analysis was performed for STN-DBS only, due to limited data on GPi-DBS and VIM-DBS. The mean body weight was higher by 6.15 kg one year after STN-DBS procedure (p < 0.001, 95% CI: 4.49-7.81), which was associated with statistically non-significant heterogeneity. It showed an increase in BMI of 1.87 kg/m2 (p < 0.001, 95% CI: 1.11-2.64). In this comprehensive review, possible causes of this state are identified, as well as the DBS impact on glucose and lipid profile.

Conclusions: STN-DBS procedures contribute to significant weight gain in PD patients. A precise mechanism of this phenomenon has several possible explanations. Until this issue is fully clarified, we believe it is necessary to continuously monitor metabolic parameters and closely observe cardiometabolic risk in this group of patients.

Keywords: Parkinson’s Disease; deep brain stimulation; glucose metabolism; lipid profile; weight gain.