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  • Comparison of efficacy of deep brain stimulation and focused ultrasound in parkinsonian tremor: a systematic review and network meta-analysis

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Neurosurgery
Review
Comparison of efficacy of deep brain stimulation and focused ultrasound in parkinsonian tremor: a systematic review and network meta-analysis
  1. Fabin Lin1,2,3,
  2. Dihang Wu1,2,3,
  3. Jiao Yu1,2,4,
  4. Huidan Weng1,2,4,
  5. Lina Chen1,2,4,
  6. Fangang Meng5,
  7. Ying Chen1,2,4,
  8. Qinyong Ye1,2,4,
  9. Guoen Cai1,2,3,4
  1. 1 Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
  2. 2 Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
  3. 3 Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
  4. 4 Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
  5. 5 Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Guoen Cai, Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China; cgessmu{at}fjmu.edu.cn; Dr Qinyong Ye, Department of Neurology, Union Hospital, Institute or Neuroscience, Fujian Medical University, Fuzhou, China; unionqyye{at}163.com

Abstract

To compare the efficacy of deep brain stimulation (DBS) and MRI-guided focused ultrasound (MRIgFUS) in parkinsonian tremor. We performed a network meta-analysis based on a Bayesian framework. We searched the literature for articles published between January 1990 and October 2020 using three databases: PubMed, Embase and Cochrane Library (The Cochrane Database of Systematic Reviews). A total of 24 studies were included in our analysis, comprising data from 784 participants. Our findings revealed similar efficacy of DBS and MRIgFUS in parkinsonian tremor suppression. Compared with internal globus pallidus (GPi)-MRIgFUS, GPi-DBS -1.84 (–6.44, 2.86), pedunculopontine nucleus (PPN)_DBS –3.28 (–9.28, 2.78), PPN and caudal zona incerta (cZI)-DBS 0.40 (–6.16, 6.87), subthalamic nucleus (STN)_DBS 0.89 (–3.48, 5.30), STN and cZI-DBS 1.99 (–4.74, 8.65), ventral intermediate nucleus(VIM)_DBS 1.75 (–2.87, 6.48), VIM_FUS 0.72 (–5.27, 6.43), cZI-DBS 0.27 (–4.75, 5.36) were no significantly difference. Compared with VIM-MRIgFUS, GPi-DBS -2.55(-6.94, 2.21), GPi-FUS -0.72 (–6.43, 5.27), PPN_DBS -4.01(–9.97, 2.11), PPN and cZI-DBS -0.32 (-6.73, 6.36), STN_DBS 0.16 (–3.98, 4.6), STN and cZI-DBS 1.31(-5.18,7.87), VIM-DBS 1.00(-3.41, 5.84)and cZI-DBS –0.43 (–5.07, 4.68) were no significantly difference. With respect to the results for the treatment of motor symptoms, GPi-DBS, GPi-MRIgFUS, STN-DBS and cZI-DBS were significantly more efficacious than baseline (GPi-DBS 15.24 (5.79, 24.82), GPi-MRIgFUS 13.46 (2.46, 25.10), STN-DBS 19.62 (12.19, 27.16), cZI-DBS 14.18 (1.73, 26.89). The results from the surface under the cumulative ranking results showed that STN-DBS ranked first, followed by combined PPN and cZI-DBS, and PPN-DBS ranked last. MRIgFUS, an efficacious intervention for improving parkinsonian tremor, has not demonstrated to be inferior to DBS in parkinsonian tremor suppression. Hence, clinicians should distinguish individual patients’ symptoms to ensure that the appropriate intervention and therapeutic approach are applied.

  • focused ultrasound
  • deep brain stimulation
  • parkinson’s disease
  • systematic review
  • meta-analysis

https://doi.org/10.1136/jnnp-2020-323656

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    Footnotes

    • FL and DW contributed equally.

    • Contributors FL and DW searched the scientific literature, collect the data and drafted the manuscript. FL, JY, LC and YC collect the data and performed statistical analyses. HW,FM and QY contributed to conception, design. GC contributed to conception, design, data interpretation, manuscript revision. All authors read and approved the manuscript.

    • Funding This work is sponsored by grants from the Fujian Province Joint Funds for the Innovation of Science and Technology(2019Y9070), Fujian Provincial Health Technology Project(2019-ZQN-48), Fujian Provincial Science and Technology Guiding Project (2018Y0033) and Fujian University of Medical Sciences Innovation and Entrepreneurship Training Program(C19080).

    • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare that all authors had financial support from the Fujian Province Joint Funds for the Innovation of Science and Technology(2019Y9070), Fujian Provincial Health Technology Project(2019-ZQN-48), Fujian Provincial Science and Technology Guiding Project (2018Y0033) and Fujian University of Medical Sciences Innovation and Entrepreneurship Training Program(C19080); authors have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities to declare that could appear to have influenced the submitted work.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.