Efficacy and safety of subthalamic nucleus deep brain stimulation combined with drug therapy for treating Parkinson's disease: a Meta-analysis

Objective: To evaluate the efficacy and safety of subthalamic nucleus deep brain stimulation (STN-DBS) combined with drug therapy for treating Parkinson's disease (PD). Methods: Retrieve relevant randomized controlled trials (RCTs) from online databases (January 1, 1980-October 1, 2016) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: subthalamic nucleus, deep brain stimulation, DBS, STN, Parkinson disease, random. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Jadad Scale and Cochrane Handbook for Systematic Reviews of Interventions. All data were pooled by RevMan 5.2 software for Meta-analysis. Results: The research enrolled 3245 articles, from which 6 studies with Jadad score ≥ 4 were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 958 PD patients were included. Meta-analysis showed that comparing with best medical treatment (BMT), STN-DBS combined with drug therapy significantly reduced the scores of Unified Parkinson's Disease Rating Scale (UPDRS)III in the "on" phase (SMD =-0.570, 95%CI:-0.710-- 0.430; P = 0.000) and in the "off" phase (SMD =-1.170, 95%CI:-1.500--0.850; P = 0.000), UPDRS I score (SMD =-0.150, 95%CI:-0.290--0.010; P = 0.030), and 39-Item Parkinson's Disease Questionnaire (PDQ-39) score (SMD =-0.510, 95%CI:-0.660--0.370; P = 0.000). But it can increase the occurrence of severe adverse events (RD = 0.140, 95% CI.: 0.090-0.190; P = 0.000) and dysarthria (RD = 0.070, 95%CI: 0.010-0.120; P = 0.020), while decrease the occurrence of dyskinesia (RR = 0.450, 95% CI.: 0.330-0.620; P = 0.000). Conclusions: Subthalamic nucleus deep brain stimulation combined with drug therapy could greatly improve motor function, mental status and quality of life of PD patients, however, clinicians should pay more attention to the increased risk of severe adverse events and dysarthria after operation.