Deep brain stimulation for Parkinson's disease: systematic review with meta-analysis and trial sequential analysis

Area of Science:

• Neurology
• Neurosurgery
• Evidence-based medicine

Background:

• Parkinson's disease is a progressive neurodegenerative disorder.
• Deep brain stimulation (DBS) is a surgical option for managing Parkinson's disease symptoms.
• The comparative benefits and harms of DBS versus drug therapy require rigorous evaluation.

Purpose of the Study:

• To systematically review and meta-analyze the benefits and harms of DBS for Parkinson's disease.
• To assess DBS efficacy and safety compared to antiparkinsonian drugs alone.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials.
• Searched multiple databases (CENTRAL, Medline, Embase, LILACS) up to May 2023.
• Included trials comparing DBS with antiparkinsonian drugs versus drugs alone, sham surgery, or resective surgery.

Main Results:

• Seven trials (1125 participants) compared DBS plus drugs versus drugs alone.
• High risk of bias and very low certainty of evidence for all primary outcomes.
• DBS increased serious adverse events (RR 2.36), mainly perioperative complications and hardware issues.
• Insufficient information size for mortality; potential symptom reduction noted but with limitations.

Conclusions:

• The certainty of evidence for DBS in Parkinson's disease is very low.
• Beneficial effects are questionable due to methodological limitations.
• DBS appears to increase serious adverse events compared to drug therapy alone.
• High-quality randomized clinical trials are crucial for definitive evaluation.