Junhuai Zhang1, Jiayu Li2, Fang Chen3, Xingzhi Liu3, Chun Jiang3, Xinghua Hu4, Lin Ma5, Zhongye Xu6. 1. Department of Neurosurgery, the First People's Hospital, Longquanyi District, Chengdu, No. 201, Group 3, Yihe, Longquanyi District, Chengdu City, Sichuan Province, People's Republic of China. Electronic address: 741735559@qq.com. 2. Department of Neurosurgery, Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), People's Republic of China. 3. Department of Neurosurgery, the First People's Hospital, Longquanyi District, Chengdu, No. 201, Group 3, Yihe, Longquanyi District, Chengdu City, Sichuan Province, People's Republic of China. 4. Department of Neurosurgery, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China. 5. Sichuan Normal University, People's Republic of China. 6. Department of Neurosurgery, Huizhou Third People's Hospital, Guangzhou Medical University, No1 Qiaodongxuebei Street, Huicheng District, Huizhou, 516002, Guangdong, People's Republic of China. Electronic address: xuzhongy1977@163.com.
Abstract
BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are currently the most common and effective surgical targets for advanced Parkinson's disease (APD). Herein, we conducted a meta-analysis to evaluate the comprehensive efficacy of STN-DBS and GPi-DBS in patients with APD. METHODS: We conducted a systematic search for relevant articles written in English in the Cochrane Library, PubMed, and EMBASE databases through January 2020. Studies comparing the efficacy and clinical outcomes of GPi-DBS and STN-DBS for APD were included and analyzed. RESULTS: Ten eligible trials with a total of 857 patients were included in this meta-analysis. The results showed no significant difference between the STN-DBS and GPi-DBS groups in Unified Parkinson's Disease Rating Scale (UPDRS) III scores during the on and off-medication phases(SMD, 0.1; 95 % CI, -0.04 to 0.25; p = 0.17, on-med), (SMD,-0.12;95 % CI -0.37 to 0.13, p = 0.33,off-med). Dyskinesia scores and the activities of daily living (ADLs) scores during the on-medication phase showed significant differences in favor of GPi stimulation (SMD, 0.16; 95 % CI, 0.01-0.32; P < 0.05)/(SMD, 0.18; 95 % CI, 0.01-0.34; P < 0.05). The ADLs score during the off-medication phase showed no significant difference between the STN-DBS and GPi-DBS groups (SMD, -0.11; 95 % CI, -0.32-0.11; P = 0.33). The LED showed significant differences in favor of STN stimulation (SMD, -0.57; 95 % CI, -0.74-0.40; P < 0.00001). CONCLUSIONS: Both STN and GPi-DBS were equally effective in improving motor dysfunction. STN-DBS was superior for medication reduction, whereas GPi-DBS perhaps led to less dyskinesia and improved the postoperative ADLs (on-medication) in APD patients. Hence, the goals of DBS can be important in the target selection. More studies comparing the adverse events and quality of life between the two targets are needed.
BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are currently the most common and effective surgical targets for advanced Parkinson's disease (APD). Herein, we conducted a meta-analysis to evaluate the comprehensive efficacy of STN-DBS and GPi-DBS in patients with APD. METHODS: We conducted a systematic search for relevant articles written in English in the Cochrane Library, PubMed, and EMBASE databases through January 2020. Studies comparing the efficacy and clinical outcomes of GPi-DBS and STN-DBS for APD were included and analyzed. RESULTS: Ten eligible trials with a total of 857 patients were included in this meta-analysis. The results showed no significant difference between the STN-DBS and GPi-DBS groups in Unified Parkinson's Disease Rating Scale (UPDRS) III scores during the on and off-medication phases(SMD, 0.1; 95 % CI, -0.04 to 0.25; p = 0.17, on-med), (SMD,-0.12;95 % CI -0.37 to 0.13, p = 0.33,off-med). Dyskinesia scores and the activities of daily living (ADLs) scores during the on-medication phase showed significant differences in favor of GPi stimulation (SMD, 0.16; 95 % CI, 0.01-0.32; P < 0.05)/(SMD, 0.18; 95 % CI, 0.01-0.34; P < 0.05). The ADLs score during the off-medication phase showed no significant difference between the STN-DBS and GPi-DBS groups (SMD, -0.11; 95 % CI, -0.32-0.11; P = 0.33). The LED showed significant differences in favor of STN stimulation (SMD, -0.57; 95 % CI, -0.74-0.40; P < 0.00001). CONCLUSIONS: Both STN and GPi-DBS were equally effective in improving motor dysfunction. STN-DBS was superior for medication reduction, whereas GPi-DBS perhaps led to less dyskinesia and improved the postoperative ADLs (on-medication) in APDpatients. Hence, the goals of DBS can be important in the target selection. More studies comparing the adverse events and quality of life between the two targets are needed.