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Original research
Quality of life outcomes after globus pallidus internus deep brain stimulation in idiopathic or inherited isolated dystonia: a meta-analysis
  1. Takashi Tsuboi1,2,
  2. James H Cauraugh3,
  3. Joshua K Wong1,
  4. Michael S Okun1,
  5. Adolfo Ramirez-Zamora1
  1. 1Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
  2. 2Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  3. 3Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Takashi Tsuboi, Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL 32608, USA; takashi80{at}gmail.com

Abstract

Background Several studies reported the beneficial effects of globus pallidus internus deep brain stimulation (GPi DBS) on health-related quality of life (HRQoL) in patients with inherited or idiopathic isolated dystonia. However, the impact of this intervention on physical and mental/psychological domains and the effects over time remain unclear.

Methods We conducted a systematic literature review from January 2000 to May 2019 and performed a meta-analysis of HRQoL outcomes based on the Short Form Health Survey-36 (SF-36) after GPi DBS in patients with inherited or idiopathic isolated dystonia to evaluate the effects of DBS on physical and mental QoL.

Results Seven studies comprising 144 patients with dystonia (78, generalised; 34, segmental; and 32, focal cervical) were included in this comprehensive analysis. The mean (SD) age at DBS implantation was 41.0 (11.4) years, and the follow-up period after implantation was 3.2 (3.8) years. The random effects model meta-analysis revealed that both physical and mental domains of SF-36 improved following DBS with a significantly larger effect size for the physical domains (effect size=0.781; p<0.0001) compared with the mental domains (effect size=0.533; p<0.0001). A moderator variable analysis demonstrated that effect sizes for HRQoL improvement were maintained over time.

Conclusions This is the first meta-analysis that demonstrates significant benefits in HRQoL following DBS in patients with inherited or idiopathic isolated dystonia. The benefits are greater for physical QoL domains compared with mental/psychological QoL. These findings highlight the importance of a comprehensive multidisciplinary approach to improve mental/psychological QoL.

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Footnotes

  • Contributors TT designed and conceptualised the study, played major roles in the systematic literature review and the statistical analysis and drafted the first manuscript. JHC played major roles in the statistical analysis and revised the manuscript for intellectual content. JW played major roles in the systematic literature review and revised the manuscript for intellectual content. MSO revised the manuscript for intellectual content. ARZ conceptualised the study and revised the manuscript for intellectual content.

  • Funding TT, JHC and JW declare no competing interests. MSO serves as a consultant for the Parkinson’s Foundation, and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association and the UF Foundation. MSO’s DBS research is supported by: R01 NR014852 and R01NS096008. MSO has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients and Cambridge (movement disorders books). MSO is an associate editor for New England Journal of Medicine Journal Watch Neurology. MSO has participated in CME and educational activities on movement disorders, in the last 36 months, sponsored by PeerView, Prime, QuantiaMD, WebMD, Medicus, MedNet, Henry Stewart and by Vanderbilt University. The institution and not MSO receives grants from Medtronic, Abbvie, Allergan and ANS/St. Jude, and the principal investigator has no financial interest in these grants. MSO has participated as a site principal investigator and/or coinvestigator for several NIH foundation, and industry-sponsored trials over the years but has not received honoraria. ARZ serves as a consultant for the Parkinson’s Foundation and has received research consulting honoraria from Medtronic, Boston scientific, CNS ratings and Bracket.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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