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Erschienen in: Journal of Neurology 11/2014

01.11.2014 | Review

Deep brain stimulation in Parkinson’s disease: meta-analysis of randomized controlled trials

verfasst von: L. Perestelo-Pérez, A. Rivero-Santana, J. Pérez-Ramos, P. Serrano-Pérez, J. Panetta, P. Hilarion

Erschienen in: Journal of Neurology | Ausgabe 11/2014

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Abstract

Until recent years there has been no evidence from randomized controlled trials (RCTs) on the efficacy of deep brain stimulation (DBS) for Parkinson’s disease (PD). This review and meta-analysis of RCTs describes the efficacy of DBS in improving motor signs, functionality and quality of life of PD patients. Several electronic databases were consulted up to April 2013. RCTs that compared DBS plus medication versus medication (alone or plus sham DBS) in PD patients were included. Outcome measures were motor function, waking time on good functioning without troublesome dyskinesias, levodopa-equivalent dose reduction, medication-induced complications, activities of daily living, health-related quality of life, and neurocognitive and psychiatric effects. Six RCTs (n = 1,184) that compared DBS plus medication versus medication alone were included. The results show that DBS significantly improves patients’ symptoms, functionality and quality of life. Effects sizes are intense for the reduction of motor signs and improvement of functionality in the off-medication phase, in addition to the reduction of the required medication dose and its associated complications. Moderate effects were observed in the case of motor signs and time in good functionality in the on-medication phase, in addition to the quality of life. Although the number of RCTs obtained is small, the total sample size is relatively large, confirming the efficacy of DBS in the control of motor signs and improvement of patients’ functionality and quality of life. More controlled research is required on the neurocognitive and psychiatric effects of DBS.
Fußnoten
1
LP: Lilisbeth Perestelo-Pérez; AR: Amado Rivero-Santana.
 
2
LP: Lilisbeth Perestelo-Pérez; AR: Amado Rivero-Santana; JPR: Jeanette Pérez-Ramos; PS: Pedro Serrano-Pérez; JP: Josefina Panetta.
 
Literatur
1.
2.
Zurück zum Zitat Rezai AR, Kopell BH, Gross RE et al (2006) Deep brain stimulation for Parkinson’s disease: surgical issues. Mov Disord 21:197–218CrossRef Rezai AR, Kopell BH, Gross RE et al (2006) Deep brain stimulation for Parkinson’s disease: surgical issues. Mov Disord 21:197–218CrossRef
3.
Zurück zum Zitat Rodriguez RL, Fernandez HH, Haq I, Okun MS (2007) Pearls in patient selection for deep brain stimulation. Neurologist 13:253–260CrossRefPubMed Rodriguez RL, Fernandez HH, Haq I, Okun MS (2007) Pearls in patient selection for deep brain stimulation. Neurologist 13:253–260CrossRefPubMed
4.
Zurück zum Zitat Benabid AL (2003) Deep brain stimulation for Parkinson’s disease. Curr Opin Neurobiol 13:696–706CrossRefPubMed Benabid AL (2003) Deep brain stimulation for Parkinson’s disease. Curr Opin Neurobiol 13:696–706CrossRefPubMed
5.
Zurück zum Zitat Pillon B, Ardouin C, Damier P et al (2000) Neuropsychological changes between “off” and “on” STN or GPi stimulation in Parkinson’s disease. Neurology 55:411–418CrossRefPubMed Pillon B, Ardouin C, Damier P et al (2000) Neuropsychological changes between “off” and “on” STN or GPi stimulation in Parkinson’s disease. Neurology 55:411–418CrossRefPubMed
6.
Zurück zum Zitat Lagrange E, Krack P, Moro E et al (2002) Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD. Neurology 59:1976–1978CrossRefPubMed Lagrange E, Krack P, Moro E et al (2002) Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD. Neurology 59:1976–1978CrossRefPubMed
7.
Zurück zum Zitat Tavella A, Bergamasco B, Bosticco E et al (2002) Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: long-term follow-up. Neurol Sci 23:S111–S112CrossRefPubMed Tavella A, Bergamasco B, Bosticco E et al (2002) Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: long-term follow-up. Neurol Sci 23:S111–S112CrossRefPubMed
8.
Zurück zum Zitat Weaver F, Follett K, Hur K, Ippolito D, Stern M (2005) Deep brain stimulation in Parkinson disease: a metaanalysis of patient outcomes. J Neurosurg 103:956–967CrossRefPubMed Weaver F, Follett K, Hur K, Ippolito D, Stern M (2005) Deep brain stimulation in Parkinson disease: a metaanalysis of patient outcomes. J Neurosurg 103:956–967CrossRefPubMed
9.
Zurück zum Zitat Kleiner-Fisman G, Herzog J, Fisman DN et al (2006) Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 21:S290–S304CrossRefPubMed Kleiner-Fisman G, Herzog J, Fisman DN et al (2006) Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 21:S290–S304CrossRefPubMed
10.
Zurück zum Zitat Andrade P, Carrillo-Ruiz JD, Jiménez F (2009) A systematic review of the efficacy of globus pallidus stimulation in the treatment of Parkinson’s disease. J Clin Neurosci 16:877–881CrossRefPubMed Andrade P, Carrillo-Ruiz JD, Jiménez F (2009) A systematic review of the efficacy of globus pallidus stimulation in the treatment of Parkinson’s disease. J Clin Neurosci 16:877–881CrossRefPubMed
11.
Zurück zum Zitat Sharma A, Szeto K, Desilets AR (2012) Efficacy and safety of deep brain stimulation as an adjunct to pharmacotherapy for the treatment of Parkinson disease. Ann Pharmacother 46:248–254CrossRefPubMed Sharma A, Szeto K, Desilets AR (2012) Efficacy and safety of deep brain stimulation as an adjunct to pharmacotherapy for the treatment of Parkinson disease. Ann Pharmacother 46:248–254CrossRefPubMed
12.
Zurück zum Zitat Parsons TD, Rogers SA, Braaten AJ, Woods SP, Tröster AI (2006) Cognitive sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a meta-analysis. Lancet Neurol 5:578–588CrossRefPubMed Parsons TD, Rogers SA, Braaten AJ, Woods SP, Tröster AI (2006) Cognitive sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a meta-analysis. Lancet Neurol 5:578–588CrossRefPubMed
13.
Zurück zum Zitat Appleby BS, Duggan PS, Regenberg A, Rabins PV (2007) Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: a meta-analysis of 10 years’ experience. Mov Disord 22:1722–1728CrossRefPubMed Appleby BS, Duggan PS, Regenberg A, Rabins PV (2007) Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: a meta-analysis of 10 years’ experience. Mov Disord 22:1722–1728CrossRefPubMed
14.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses. Ann Int Med 151:264–269CrossRef Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses. Ann Int Med 151:264–269CrossRef
15.
Zurück zum Zitat DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trial 7:177–188CrossRef DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trial 7:177–188CrossRef
16.
Zurück zum Zitat Deuschl G, Schade-Brittinger C, Krack P et al (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355:896–908CrossRefPubMed Deuschl G, Schade-Brittinger C, Krack P et al (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355:896–908CrossRefPubMed
17.
Zurück zum Zitat Witt K, Daniels C, Reiff J et al (2008) Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: a randomised, multicentre study. Lancet Neurol 7:605–614CrossRefPubMed Witt K, Daniels C, Reiff J et al (2008) Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: a randomised, multicentre study. Lancet Neurol 7:605–614CrossRefPubMed
18.
Zurück zum Zitat Schüpbach WMM, Maltête D, Houeto JL et al (2007) Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology 68:267–271CrossRefPubMed Schüpbach WMM, Maltête D, Houeto JL et al (2007) Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology 68:267–271CrossRefPubMed
19.
Zurück zum Zitat Weaver FM, Follett K, Stern M et al (2009) Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 301:63–73PubMedCentralCrossRefPubMed Weaver FM, Follett K, Stern M et al (2009) Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 301:63–73PubMedCentralCrossRefPubMed
20.
Zurück zum Zitat Williams A, Gill S, Varma T et al (2010) Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 9:581–591PubMedCentralCrossRefPubMed Williams A, Gill S, Varma T et al (2010) Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 9:581–591PubMedCentralCrossRefPubMed
21.
Zurück zum Zitat Okun MS, Gallo BV, Mandybur G et al (2012) Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 11:140–149CrossRefPubMed Okun MS, Gallo BV, Mandybur G et al (2012) Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 11:140–149CrossRefPubMed
22.
Zurück zum Zitat Schuepbach WMM, Rau J, Knudsen K et al (2013) Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 368:610–622CrossRefPubMed Schuepbach WMM, Rau J, Knudsen K et al (2013) Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 368:610–622CrossRefPubMed
23.
Zurück zum Zitat Schüpbach WM, Chastan N, Welter ML et al (2005) Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up. J Neurol Neurosurg Psychiatry 76:1640–1644PubMedCentralCrossRefPubMed Schüpbach WM, Chastan N, Welter ML et al (2005) Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up. J Neurol Neurosurg Psychiatry 76:1640–1644PubMedCentralCrossRefPubMed
24.
Zurück zum Zitat Kleiner-Fisman G, Fisman DN, Sime E, Saint-Cyr JA, Lozano AM, Lang AE (2003) Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 99:489–495CrossRefPubMed Kleiner-Fisman G, Fisman DN, Sime E, Saint-Cyr JA, Lozano AM, Lang AE (2003) Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 99:489–495CrossRefPubMed
25.
Zurück zum Zitat Follett KA, Weaver FM, Stern M et al (2010) Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J Med 362:2077–2091CrossRefPubMed Follett KA, Weaver FM, Stern M et al (2010) Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J Med 362:2077–2091CrossRefPubMed
26.
Zurück zum Zitat Burkhard PR, Vingerhoets FJ, Berney A, Bogousslavsky J, Villemure JG, Ghika J (2004) Suicide after successful deep brain stimulation for movement disorders. Neurology 63:2170–2172CrossRefPubMed Burkhard PR, Vingerhoets FJ, Berney A, Bogousslavsky J, Villemure JG, Ghika J (2004) Suicide after successful deep brain stimulation for movement disorders. Neurology 63:2170–2172CrossRefPubMed
27.
Zurück zum Zitat Soulas T, Gurruchaga JM, Palfi S, Cesaro P, Nguyen JP, Fénelon G (2008) Attempted and completed suicides after subthalamic nucleus stimulation for Parkinson’s disease. J Neurol Neurosurg Psychiatry 79:952–954CrossRefPubMed Soulas T, Gurruchaga JM, Palfi S, Cesaro P, Nguyen JP, Fénelon G (2008) Attempted and completed suicides after subthalamic nucleus stimulation for Parkinson’s disease. J Neurol Neurosurg Psychiatry 79:952–954CrossRefPubMed
28.
Zurück zum Zitat Voon V, Krack P, Lang AE et al (2008) A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain 131:2720–2728PubMedCentralCrossRefPubMed Voon V, Krack P, Lang AE et al (2008) A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain 131:2720–2728PubMedCentralCrossRefPubMed
29.
Zurück zum Zitat Weintraub D, Duda JE, Carlson K et al (2013) Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial. J Neurol Neurosurg Psychiatry 84:1113–1118CrossRefPubMed Weintraub D, Duda JE, Carlson K et al (2013) Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial. J Neurol Neurosurg Psychiatry 84:1113–1118CrossRefPubMed
30.
Zurück zum Zitat Tsai ST, Hung HY, Hsieh TC, Lin SH, Lin SZ, Chen SY (2013) Long-term outcome of young onset Parkinson’s disease after subthalamic stimulation—a cross-sectional study. Clin Neurol Neurosurg 115:2082–2087CrossRefPubMed Tsai ST, Hung HY, Hsieh TC, Lin SH, Lin SZ, Chen SY (2013) Long-term outcome of young onset Parkinson’s disease after subthalamic stimulation—a cross-sectional study. Clin Neurol Neurosurg 115:2082–2087CrossRefPubMed
31.
Zurück zum Zitat St George RJ, Nutt JG, Burchiel KJ, Horak FB (2010) A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurology 75:1292–1299PubMedCentralCrossRefPubMed St George RJ, Nutt JG, Burchiel KJ, Horak FB (2010) A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurology 75:1292–1299PubMedCentralCrossRefPubMed
32.
Zurück zum Zitat Robertson LT, St George RJ, Carlson-Kuhta P, Hogarth P, Burchiel KJ, Horak FB (2011) Site of deep brain stimulation and jaw velocity in Parkinson disease. J Neurosurg 115:985–994PubMedCentralCrossRefPubMed Robertson LT, St George RJ, Carlson-Kuhta P, Hogarth P, Burchiel KJ, Horak FB (2011) Site of deep brain stimulation and jaw velocity in Parkinson disease. J Neurosurg 115:985–994PubMedCentralCrossRefPubMed
33.
Zurück zum Zitat Weaver FM, Follett KA, Stern M et al (2012) Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology 79:55–65PubMedCentralCrossRefPubMed Weaver FM, Follett KA, Stern M et al (2012) Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology 79:55–65PubMedCentralCrossRefPubMed
34.
Zurück zum Zitat St George RJ, Carlson-Kuhta P, Burchiel KJ, Hogarth P, Frank N, Horak FB (2012) The effects of subthalamic and pallidal deep brain stimulation on postural responses in patients with Parkinson disease. J Neurosurg 116:1347–1356PubMedCentralCrossRefPubMed St George RJ, Carlson-Kuhta P, Burchiel KJ, Hogarth P, Frank N, Horak FB (2012) The effects of subthalamic and pallidal deep brain stimulation on postural responses in patients with Parkinson disease. J Neurosurg 116:1347–1356PubMedCentralCrossRefPubMed
35.
Zurück zum Zitat Odekerken VJ, van Laar T, Staal MJ et al (2013) Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson’s disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 12:37–44CrossRefPubMed Odekerken VJ, van Laar T, Staal MJ et al (2013) Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson’s disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 12:37–44CrossRefPubMed
36.
Zurück zum Zitat Temel Y, Wilbrink P, Duits A et al (2007) Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. Neurosurgery 61:346–355CrossRefPubMed Temel Y, Wilbrink P, Duits A et al (2007) Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. Neurosurgery 61:346–355CrossRefPubMed
37.
Zurück zum Zitat Temel Y, Prinsenberg T, Visser-Vandewalle V (2008) Imaging of the subthalamic nucleus for deep brain stimulation: a systematic review. Neuromodulation 11:8–12CrossRefPubMed Temel Y, Prinsenberg T, Visser-Vandewalle V (2008) Imaging of the subthalamic nucleus for deep brain stimulation: a systematic review. Neuromodulation 11:8–12CrossRefPubMed
38.
Zurück zum Zitat Farris S, Giroux M (2013) Retrospective review of factors leading to dissatisfaction with subthalamic nucleus deep brain stimulation during long-term management. Surg Neurol Int 4:69PubMedCentralCrossRefPubMed Farris S, Giroux M (2013) Retrospective review of factors leading to dissatisfaction with subthalamic nucleus deep brain stimulation during long-term management. Surg Neurol Int 4:69PubMedCentralCrossRefPubMed
39.
Zurück zum Zitat Angeli A, Mencacci NE, Duran R et al (2013) Genotype and phenotype in Parkinson’s disease: lessons in heterogeneity from deep brain stimulation. Mov Disord 28:1370–1375PubMedCentralCrossRefPubMed Angeli A, Mencacci NE, Duran R et al (2013) Genotype and phenotype in Parkinson’s disease: lessons in heterogeneity from deep brain stimulation. Mov Disord 28:1370–1375PubMedCentralCrossRefPubMed
Metadaten
Titel
Deep brain stimulation in Parkinson’s disease: meta-analysis of randomized controlled trials
verfasst von
L. Perestelo-Pérez
A. Rivero-Santana
J. Pérez-Ramos
P. Serrano-Pérez
J. Panetta
P. Hilarion
Publikationsdatum
01.11.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 11/2014
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-014-7254-6

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