The long-term efficacy of STN vs GPi deep brain stimulation for Parkinson disease A meta-analysis

Objective: This meta-analysis assessed the long-term efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus interna (GPi) for Parkinson disease (PD). Methods: PubMed, Cochrane Library, and Clinical Trials databases were searched. Outcomes were unified Parkinson disease rating scale section (UPDRS) III off-medication score, Parkinson's disease questionnaire: 39 activities of daily living (PDQ-39 ADL) score, and levodopa-equivalent dosage after DBS. Results: During the off-medication state, pooled weighted mean difference (WMD) of UPDRS III score was .69 (95% confidence interval [CI]=-1.77 to 3.16, P=.58). In subgroup analysis, WMD of UPDRS III off-medication scores from baseline to 2 years and 3 years post-DBS were -.61 (95% CI=-2.97 to 1.75, P=.61) and 2.59 (95% CI=-2.30 to 7.47, P=.30). PooledWMDof changes in tremor, rigidity, and gait scores were 1.12 (95% CI=-0.05 to 2.28, P=.06), 1.22 (95% CI=-0.51 to 2.94, P=.17) and.37 (95% CI=-0.13 to 0.87, P=.15), respectively. After DBS, pooled WMD of PDQ-39 ADL and LED were -3.36 (95% CI=-6.36 to -0.36, P=.03) and 194.89 (95% CI=113.16 to 276.63, P<.001). Conclusions: STN-DBS and GPi-DBS improve motor function and activities of daily living for PD. Differences in the long-term efficacy for PD on motor symptoms were not observed.