Background This umbrella review summarizes the evidence across meta-analyses regarding the effectiveness and adverse effects of deep brain stimulation (DBS). Methods Databases were searched up to March 2015 for meta-analyses of comparative trials in humans assessing the effectiveness or adverse effects of DBS. Data selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Results Seven eligible systematic reviews were included assessing the use of DBS for epilepsy (n = 1), obsessive-compulsive disorder (n = 1), and Parkinson disease (n = 5). The summary estimates were significant at p ≤ 0.05 in four meta-analyses (27%) with both fixed and random effects. One meta-analysis reported that DBS was more effective than sham in reducing the Yale-Brown Obsessive Compulsive Scale score in obsessive-compulsive disorder patients. The remaining three meta-analyses reported differences regarding mortality and depression in patients with Parkinson disease between DBS of the subthalamic nucleus and of the globus pallidus internus. Of the 15 meta-analyses, none compiled adequately robust evidence. Conclusions Although DBS has emerged as a viable surgical intervention to treat various disabling neurologic symptoms, existing studies fail to adequately support its use based on robust evidence without hints of bias.
INTRODUCTION: Around 1% of adults have Parkinson's disease, with a median time of 9 years between diagnosis and death.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments in people with early-stage Parkinson's disease? What are the effects of adding other treatments in people with Parkinson's disease who have motor complications from levodopa? What are the effects of surgery in people with later Parkinson's disease? What are the effects of nursing and rehabilitation treatments in people with Parkinson's disease? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 59 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding a catechol-methyl transferase inhibitor, or dopamine agonist to levodopa; amantadine; dopamine agonists; levodopa (immediate-release, modified-release); monoamine oxidase B inhibitors; occupational therapy; pallidal deep brain stimulation; pallidotomy; Parkinson's disease nurse specialist interventions; physiotherapy; speech and language therapy; subthalamic nucleus deep brain stimulation; subthalamotomy; swallowing therapy; thalamic deep brain stimulation; and thalamotomy.
Background This umbrella review summarizes the evidence across meta-analyses regarding the effectiveness and adverse effects of deep brain stimulation (DBS). Methods Databases were searched up to March 2015 for meta-analyses of comparative trials in humans assessing the effectiveness or adverse effects of DBS. Data selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Results Seven eligible systematic reviews were included assessing the use of DBS for epilepsy (n = 1), obsessive-compulsive disorder (n = 1), and Parkinson disease (n = 5). The summary estimates were significant at p ≤ 0.05 in four meta-analyses (27%) with both fixed and random effects. One meta-analysis reported that DBS was more effective than sham in reducing the Yale-Brown Obsessive Compulsive Scale score in obsessive-compulsive disorder patients. The remaining three meta-analyses reported differences regarding mortality and depression in patients with Parkinson disease between DBS of the subthalamic nucleus and of the globus pallidus internus. Of the 15 meta-analyses, none compiled adequately robust evidence. Conclusions Although DBS has emerged as a viable surgical intervention to treat various disabling neurologic symptoms, existing studies fail to adequately support its use based on robust evidence without hints of bias.
