A systematic review of health disparities research in deep brain stimulation surgery for Parkinson’s disease
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ABSTRACT:
SUBMITTER: Memon A
PROVIDER: S-EPMC10641459 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD) patients with motor fluctuations and dyskinesias. The key DBS efficacy studies were performed in PD patients with unknown genotypes; however, given the estimated monogenic mutation prevalence of approximately 5-10%, most commonly LRRK2, PRKN, PINK1 and SNCA, and risk-increasing genetic factors such as GBA, proper characterization is becoming increasingly relevant. We performed a systematic review of 46 studies that reported DBS effects in 221 genetic PD patients. The results suggest that monogenic PD patients have variable DBS benefit depending on the mutated gene. Outcome appears excellent in patients with the most common LRRK2 mutation, p.G2019S, and good in patients with PRKN mutations but poor in patients with the more rare LRRK2 p.R1441G mutation. The overall benefit of DBS in SNCA, GBA and LRRK2 p.T2031S mutations may be compromised due to rapid progression of cognitive and neuropsychiatric symptoms. In the presence of other mutations, the motor changes in DBS-treated monogenic PD patients appear comparable to those of the general PD population.
| S-EPMC7109183 | biostudies-literature
Project description:BackgroundSTN-DBS is a cornerstone in the treatment of advanced Parkinson's disease (PD). The traditional approach is to use an awake operative technique with microelectrode recording (MER). However, more centers start using an asleep MRI-guided technique without MER.ObjectiveWe systematically reviewed the literature to compare STN-DBS surgery with and without MER for differences in clinical outcome.MethodsWe systematically searched PubMed, Embase, MEDLINE, and Web of Science databases for randomized clinical trials and consecutive cohort studies published between 01-01-2000 and 26-08-2021, that included at least 10 PD patients who had received bilateral STN-DBS.Results2,129 articles were identified. After abstract screening and full-text review, 26 studies were included in the final analysis, comprising a total of 34 study groups (29 MER and 5 non-MER). The standardized mean difference (SMD) in change in motor symptoms between baseline (OFF medication) and 6-24 months follow-up (OFF medication and ON stimulation) was 1.64 for the MER group and 1.87 for non-MER group (p = 0.59). SMD in change in levodopa equivalent daily dose (LEDD) was 1.14 for the MER group and 0.65 for non-MER group (p < 0.01). Insufficient data were available for comparative analysis of PDQ-39 and complications.ConclusionThe change in motor symptoms from baseline to follow-up did not differ between studies that used MER and those that did not. The postoperative reduction in LEDD from baseline to follow-up was greater in the MER-group. In the absence of high-quality studies comparing both methods, there is a clear need for a well-designed comparative trial.
| S-EPMC9661327 | biostudies-literature
Project description:OBJECTIVE:To review and synthesise qualitative research studies that have explored patients' experience of deep brain stimulation (DBS) in advanced Parkinson's disease (PD). DESIGN:Systematic review and meta-synthesis of 7 original papers, using metaethnography. SETTING:Studies conducted in Denmark, France and Sweden. PARTICIPANTS:116 patients who had undergone DBS and 9 spouses of patients. RESULTS:Prior to surgery, the experience of advancing PD is one of considerable loss and a feeling of loss of control. There are significant hopes for what DBS can bring. Following surgery, a sense of euphoria is described by many, although this does not persist and there is a need for significant transitions following this. We suggest that normality as a concept is core to the experience of DBS and that a sense of control may be a key condition for normality. Experience of DBS for patients and spouses, and of the transitions that they must undertake, is influenced by their hopes of what surgery will enable them to achieve, or regain (ie, a new normality). CONCLUSIONS:There is a need for further qualitative research to understand the nature of these transitions to inform how best patients and their spouses can be supported by healthcare professionals before, during and after DBS. In assessing the outcomes of DBS and other treatments in advanced PD, we should consider how to capture holistic concepts such as normality and control. Studies that examine the outcomes of DBS require longer term follow-up.
| S-EPMC4932278 | biostudies-other
Project description:IntroductionParkinson's disease (PD) patients have a significantly higher risk of developing dementia in later disease stages, leading to severe impairments in quality of life and self-functioning. Questions remain on how deep brain stimulation (DBS) affects cognition, and whether we can individualize therapy and reduce the risk for adverse cognitive effects. Our aim in this systematic review is to assess the current knowledge in the field and determine if the findings could influence clinical practice.MethodsWe have conducted a systematic review according to PRISMA guidelines through MEDLINE and Embase databases, with studies being selected for inclusion via a set inclusion and exclusion criteria.ResultsSixty-seven studies were included in this systematic review according to the selected criteria. This includes 6 meta-analyses, 18 randomized controlled trials, 17 controlled clinical trials, and 26 observational studies with no control arms. The total number of PD patients encompassed in the studies cited in this review is 3677, not including the meta-analyses.ConclusionCognitive function in PD patients can deteriorate, in most cases mildly, but still impactful to the quality of life. The strongest evidence is present for deterioration in verbal fluency, while inconclusive evidence is still present for executive function, memory, attention and processing speed. Global cognition does not appear to be significantly impacted by DBS, especially if cognitive screening is performed prior to the procedure, as lower baseline cognitive function is connected to poor outcomes. Further randomized controlled studies are required to increase the level of evidence, especially in the case of globus pallidus internus DBS, pedunculopontine nucleus DBS, and the ventral intermediate nucleus of thalamus DBS, and more long-term studies are required for all respective targets.
| S-EPMC9135964 | biostudies-literature
Project description:While the efficacy of deep brain stimulation (DBS) is well-established in Parkinson's Disease (PD), the benefit of DBS varies across patients. Using imaging features for outcome prediction offers potential in improving effectiveness, whereas the value of presurgical brain morphometry, derived from the routinely used imaging modality in surgical planning, remains under-explored. This review provides a comprehensive investigation of links between DBS outcomes and brain morphometry features in PD. We systematically searched PubMed and Embase databases and retrieved 793 articles, of which 25 met inclusion criteria and were reviewed in detail. A majority of studies (24/25), including 1253 of 1316 patients, focused on the outcome of DBS targeting the subthalamic nucleus (STN), while five studies included 57 patients receiving globus pallidus internus (GPi) DBS. Accumulated evidence showed that the atrophy of motor cortex and thalamus were associated with poor motor improvement, other structures such as the lateral-occipital cortex and anterior cingulate were also reported to correlated with motor outcome. Regarding non-motor outcomes, decreased volume of the hippocampus was reported to correlate with poor cognitive outcomes. Structures such as the thalamus, nucleus accumbens, and nucleus of basalis of Meynert were also reported to correlate with cognitive functions. Caudal middle frontal cortex was reported to have an impact on postsurgical psychiatric changes. Collectively, the findings of this review emphasize the utility of brain morphometry in outcome prediction of DBS for PD. Future efforts are needed to validate the findings and demonstrate the feasibility of brain morphometry in larger cohorts.
| S-EPMC9556527 | biostudies-literature
Project description:BackgroundDeep brain stimulation (DBS) surgery is offered to a subset of Parkinson's disease (PD) patients. It is unclear if there are features at diagnosis that predict future DBS surgery.ObjectiveTo assess predictors of eventual DBS surgery in de novo PD patients.MethodsSubjects from the Parkinson's Progression Marker Initiative (PPMI) database with newly diagnosed, sporadic PD (n = 416) were identified and stratified by their eventual DBS status (DBS+, n = 43; DBS-, n = 373). A total of 50 baseline clinical, imaging, and biospecimen features were extracted for each subject and cross-validated lasso regression was used for feature reduction. Multivariate logistic regression assessed their relationship with DBS status and a receiver operating characteristic curve evaluated model performance. Linear mixed effect models assessed disease progression over 4 years in DBS+ and DBS- patients.ResultsAge at symptom onset, Hoehn and Yahr (H&Y) stage, tremor score, and ratio of CSF Tau to amyloid-beta 1-42 (Tau: Ab) were identified as important baseline features for predicting DBS surgery. Each independently predicted DBS surgery (area under the curve = 0.83). DBS- patients had faster memory decline (P < 0.05), while DBS+ patients had faster decline in H&Y stage (P < 0.001) and motor scores (P < 0.05) prior to surgery.ConclusionThe identified features may be used for early identification of patients who may be surgical candidates during the course of their disease. Disease progression in these groups reflects surgical eligibility criteria, with DBS- patients having more rapid decline in memory while DBS+ patients experienced a faster decline in motor scores prior to DBS surgery.
| S-EPMC10272891 | biostudies-literature
Project description:BackgroundDeep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD), and careful selection of candidates is a key component of successful therapy. Although it is recognized that factors such as age, disease duration, and levodopa responsiveness can influence outcomes, it is unclear whether genetic background should also serve as a parameter.ObjectivesThe aim of this systematic review is to explore studies that have evaluated DBS in patients with mutations in PD-related genes.MethodsWe performed a selective literature search for articles regarding the effects of DBS in autosomal dominant or recessive forms of PD or in PD patients with genetic risk factors. Data regarding changes in motor and nonmotor scores and the presence of adverse events after the stimulation were collected.ResultsA total of 25 studies were included in the systematic review, comprising 135 patients. In the shorter term, most patients showed marked or satisfactory response to subthalamic DBS, although leucine rich repeat kinase 2 carriers of R114G mutations had higher rates of unsatisfactory outcome. Longer term follow-up data were scarce but suggested that motor benefit is sustained. Patients with the glucosidase beta acid (GBA) mutation showed higher rates of cognitive decline after surgery. Motor outcome was scarce for pallidal DBS. Few adverse events were reported.ConclusionsSubthalamic DBS results in positive outcomes in the short term in patients with Parkin, GBA, and leucine-rich repeat kinase 2 (non-R144G) mutations, although the small sample size limits the interpretation of our findings. Longer and larger cohorts of follow-up, with broader nonmotor symptom evaluations will be necessary to better customize DBS therapy in this population.
| S-EPMC6592794 | biostudies-literature
Project description:BackgroundThe up-to-date literature systematically reviewing the predictive value of preoperative levodopa responsiveness after deep brain stimulation (DBS) surgery in motor outcomes in Parkinson's disease (PD) is lacking.ObjectiveTo address this issue in patients with PD undergoing bilateral subthalamic nucleus (STN) or globus pallidus interna (GPi) DBS.MethodsWe used the existing PRISMA consensus statement. A comprehensive review of literature from 1993 to May 2021 retrieved from PubMed was conducted.ResultsThe STN-DBS responsiveness was significantly correlated with the preoperative levodopa responsiveness for the total score of UPDRS-III at both 6- and 12-month follow-ups (P < 0.001). Such correlations were significant after controlling for age at time of surgery and disease duration. The significance of correlation disappeared for longer follow-up times. For the sub-scores of UPDRS-III, a significant correlation between the preoperative levodopa responsiveness and STN DBS responsiveness was observed for rigidity, bradykinesia, and axial symptoms, but not for tremor (P = 0.002, 0.010, 0.007, and 0.542, respectively). The preoperative levodopa responsiveness was significantly correlated with GPi DBS responsiveness for the UPDRS-III total score at a median follow-up of 12 months (P = 0.030).ConclusionThe current study confirmed the value of preoperative levodopa responsiveness for prediction of the short-term motor outcome after DBS (for both STN and GPi). The predictive value of levodopa responsiveness in short-term outcomes for respective cardinal motor disabilities and the loss of its predictive value after STN DBS for long-term motor outcomes were highlighted by this study.
| S-EPMC8810442 | biostudies-literature
Project description:ObjectivesDeep Brain Stimulation (DBS) effectively treats Parkinson's motor symptoms, but its effects on the urogenital system are debated.MethodsA research was conducted in PubMed, Embase, Cochrane Library, Web of Science, and Scopus until February 27, 2024. We primarily focused on DBS's impact on Parkinson's patients' Urine storage function, voiding function, sexual function, and quality of life.ResultsOur meta-analysis included 14 studies. The main results showed that DBS resulted in fewer instances of urinary urgency (OR = 1.85, 95% CI: 1.26 to 2.70, p = 0.002) and increased maximum bladder capacity (MD = -66.10, 95% CI: -119.37 to -12.82, p = 0.02) in terms of urinary storage function. However, there were no significant differences in first desire to void and strong desire to void. In terms of voiding function, DBS showed significant improvements in maximum flow rate (MD = -0.64, 95% CI: -1.23 to -0.05, p = 0.03), post-void residual (MD = -6.79, 95% CI: 4.54 to 9.05, P < 0.00001) and detrusor pressure during maximum flow (MD = -1.37, 95% CI: -2.73 to -0.02, p = 0.05). Additionally, there was no significant difference in sexual function between the two groups (MD = -1.41, 95% CI: -12.40 to 9.57, p = 0.80).ConclusionDBS has demonstrated a certain degree of efficacy in ameliorating urinary storage and voiding function in patients with Parkinson's disease. However, certain urodynamic parameters or scores do not demonstrate any statistically significant disparities. Furthermore, DBS has no significant impact on erectile function in male Parkinson's patients.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023476661, identifier CRD42023476661.
| S-EPMC11254620 | biostudies-literature
Project description:BackgroundPostoperative delirium (POD) is a serious complication following deep brain stimulation (DBS) but only received little attention. Its main risk factors are higher age and preoperative cognitive deficits. These are also main risk factors for long-term cognitive decline after DBS in Parkinson's disease (PD).ObjectiveTo identify risk factors for POD severity after DBS surgery in PD.Methods57 patients underwent DBS (21 female; age 60.2±8.2; disease duration 10.5±5.9 years). Preoperatively, general, PD- and surgery-specific predictors were recorded. Montreal Cognitive Assessment and the neuropsychological test battery CANTAB ConnectTM were used to test domain-specific cognition. Volumes of the cholinergic basal forebrain were calculated with voxel-based morphometry. POD severity was recorded with the delirium scales Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Nursing Delirium Scale (NU-DESC). Spearman correlations were calculated for univariate analysis of predictors and POD severity and linear regression with elastic net regularization and leave-one-out cross-validation was performed to fit a multivariable model.Results21 patients (36.8%) showed mainly mild courses of POD following DBS. Correlation between predicted and true POD severity was significant (spearman rho = 0.365, p = 0.001). Influential predictors were age (p < 0.001), deficits in attention and motor speed (p = 0.002), visual learning (p = 0.036) as well as working memory (p < 0.001), Nucleus basalis of Meynert volumes (p = 0.003) and burst suppression (p = 0.005).ConclusionsGeneral but also PD- and surgery-specific factors were predictive of POD severity. These findings underline the multifaceted etiology of POD after DBS in PD. Valid predictive models must therefore consider general, PD- and surgery-specific factors.
| S-EPMC11380232 | biostudies-literature