Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida College of Medicine, Gainesville, FL, USA.
Motor Behavior Laboratory, University of Florida, Gainesville, FL, USA.
Parkinsonism Relat Disord. 2019 Jan;58:56-62. doi: 10.1016/j.parkreldis.2018.08.017. Epub 2018 Aug 28.
To compare subthalamic nucleus (STN) deep brain stimulation (DBS) with globus pallidus interna (GPi) DBS for tremor suppression in Parkinson disease (PD).
DBS is an effective surgical therapy that has been shown to provide significant benefit for motor symptoms in PD. Currently, two main structures targeted to treat motor complications in PD are the STN and GPi. Although some groups traditionally favor STN over GPi for tremor suppression, evidence demonstrating superiority in long-term tremor control is limited.
We performed a systematic review for all randomized trials comparing STN vs GPi DBS in PD that were published before March 2017. Five studies were examined in a random effects model meta-analysis. We conducted moderator variable analysis to determine if there was a treatment effect difference for STN versus GPi.
We compared DBS ON versus OFF and found a significant overall standardized difference mean effect: Effect Size = 0.36; 95% CI = 0.316-0.395; P < 0.0001. These findings indicate that DBS reduced tremor symptoms in PD patients with a medium effect size. Moderator variable analysis of STN vs GPI revealed two significant standardized effect sizes: STN effect size = 0.38 and GPi effect size = 0.35. A Z-test showed that effect sizes between the STN and GPi were not significantly different (P = 0.56).
DBS is effective in reducing tremor in PD patients regardless of stimulation target. However, the degree of tremor suppression in STN DBS versus GPi DBS was equivalent.
比较丘脑底核（STN）深部脑刺激（DBS）与苍白球内侧部（GPi）DBS 抑制帕金森病（PD）震颤的效果。
DBS 是一种有效的手术治疗方法，已被证明对 PD 的运动症状有显著益处。目前，有两个主要的结构被用来治疗 PD 的运动并发症，即 STN 和 GPi。尽管一些小组传统上倾向于 STN 而不是 GPi 来抑制震颤，但在长期震颤控制方面的优势证据有限。
我们对所有在 2017 年 3 月之前发表的比较 STN 与 GPi DBS 治疗 PD 的随机试验进行了系统评价。在随机效应模型荟萃分析中检查了五项研究。我们进行了调节变量分析，以确定 STN 与 GPi 之间是否存在治疗效果差异。
我们比较了 DBS 开启与关闭时的效果，发现总体标准化均数差效应有显著差异：效应大小=0.36；95%置信区间=0.316-0.395；P<0.0001。这些发现表明，DBS 可降低 PD 患者的震颤症状，且效应中等。STN 与 GPI 的调节变量分析显示了两个有显著意义的标准化效应大小：STN 效应大小=0.38，GPi 效应大小=0.35。Z 检验表明，STN 和 GPi 之间的效应大小没有显著差异（P=0.56）。
DBS 对 PD 患者震颤的治疗效果有效，与刺激靶点无关。然而，STN DBS 与 GPi DBS 抑制震颤的程度相当。
