Objective: The aim of this meta-analysis is to compare mortality after subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) for patients with Parkinson’s disease (PD).

Background: DBS is a surgical treatment for patients with advanced PD. STN and GPi are the most common stimulation targets for DBS in patients with PD. Postoperative complications might limit the use of DBS, however, till the moment, there is no head to head comparison between DBS STN and DBS GPi in terms of mortality after surgery. In this meta-analysis, we are comparing the risk of mortality between the two groups using data from prospective clinical trials.

Methods: We searched PubMed through September, 2016 for prospective controlled studies comparing STN DBS and GPi DBS for PD patients. Records were screened for prospective controlled trials comparing STN DBS and GPi DBS for PD patients. Data were extracted by the study reviewers independently and quality of included studies was assessed by the Cochrane risk of bias assessment tool. Frequency of mortality in both groups were pooled as risk ration between the two groups in a fixed effect model meta-analysis. In case of multiple reports, we analysed data from the most recent data set. We introduced subgroup analysis according to the follow up duration to investigate whether the effect size differed from different time periods. Heterogeneity was assessed by visual inspection of the forest plots and measured by I-square and Chi-Square tests. We used RevMan 5.3 for windows.

Results: Four trials (7 full text articles) were included in the final analysis with a total of 479 patients (STN 253 patients, and GPi 226 patients). Follow up duration ranged from 6 months in COMPARE trial to 6 years in the study of DBS group 2001. The overall risk ratio favoured GPi DBS than STN DBS with RR 3.64, 95% CI (1.68 to 7.87). This results suggests more than 3-fold increase in mortality following STN DBS than GPi DBS.

Conclusions: Death was more common after STN DBS than GPi DBS in PD patients. But most of death cases were due to postoperative complications and were not related directly to stimulation. Our results highlight the importance of considering postoperative complication while choosing surgical target for PD patients.

References: Weaver FM, Follett KA, Stern M, et al. Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology 2012;79(1):55-65. doi:10.1212/WNL.0b013e31825dcdc1.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/meta-analysis-of-mortality-following-subthalamic-and-pallidal-deep-brain-stimulation-for-patients-with-parkinsons-disease/