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

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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.

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Notes

  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.

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Acknowledgments

The authors would like to thank to Leticia Cuellar for her technical assistance with the search strategies and to Mª Carmen Bujalance for her assistance with the literature retrieval. The authors would also like to thank Jason Willis-Lee for his copyediting support. This study was funded by Spanish Health Ministry (Ministerio de Sanidad, Servicios Sociales e Igualdad).

Conflicts of interest

All authors stated that there are no conflicts of interest regarding the publication of this article.

Ethical standard

The manuscript does not contain clinical studies or patient data.

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Authors and Affiliations

  1. Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain

    L. Perestelo-Pérez

  2. Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain

    L. Perestelo-Pérez, A. Rivero-Santana & P. Hilarion

  3. Canarian Islands Foundation of Health and Research (FUNCIS), Tenerife, Spain

    A. Rivero-Santana & J. Pérez-Ramos

  4. Department of Psychiatry, University Hospital La Princesa, Madrid, Spain

    P. Serrano-Pérez

  5. Preventive Medicine Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Gran Canaria, Spain

    J. Panetta

  6. Avedis Donabedian University Institute, Barcelona, Spain

    P. Hilarion

  7. Autonomus University of Barcelona, Barcelona, Spain

    P. Hilarion

Authors
  1. L. Perestelo-Pérez
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  2. A. Rivero-Santana
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  3. J. Pérez-Ramos
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  4. P. Serrano-Pérez
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  5. J. Panetta
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  6. P. Hilarion
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Corresponding author

Correspondence to L. Perestelo-Pérez.

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Perestelo-Pérez, L., Rivero-Santana, A., Pérez-Ramos, J. et al. Deep brain stimulation in Parkinson’s disease: meta-analysis of randomized controlled trials. J Neurol 261, 2051–2060 (2014). https://doi.org/10.1007/s00415-014-7254-6

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  • DOI: https://doi.org/10.1007/s00415-014-7254-6

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