Deep brain stimulation of pedunculopontine nucleus for postural instability and gait disorder after Parkinson's disease: a meta-analysis of individual patient data.

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Deep brain stimulation of pedunculopontine nucleus for postural instability and gait disorder after Parkinson's disease: a meta-analysis of individual patient data.

World Neurosurg. 2017 Mar 06;:

Authors: Wang JW, Zhang YQ, Zhang XH, Wang YP, Li JP, Li YJ

Abstract
BACKGROUND: Postural instability and gait disorder(PIGD) in Parkinson's disease (PD) have been a great challenge in the clinical practice since PIGD is closely linked to major morbidity and mortality in PD. Pedunculopontine nucleus (PPN) has been considered as a potential promising target for deep brain stimulation (DBS) in the treatment of PIGD. Thus, this meta-analysis of individual patient data (IPD) was performed to assess the effects of PPN DBS on PIGD in PD patients and explore the factors predicting good outcome.
METHODS: According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials, and other sources. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included PIGD, freezing of gait (FOG) and falling in PD. Then individual patient data was incorporated into SPSS software for statistical analyses across series.
RESULTS: Six studies reporting IPD were included for final analysis. PPN DBS significantly improved PIGD as well as freezing of gait and falling after PD, which was depending on the duration of follow-up and types of outcome measures. In addition, patient age, disease duration, levodopa-equivalent dosage, and the choice of unilateral or bilateral stimulation was similar in groups of PD patients with or without improvement in PIGD after PPN DBS.
CONCLUSIONS: Our study provides evidence that PPN DBS may improve PIGD, which should be interpreted with caution and needs further verification before making generalization of our results.

PMID: 28279773 [PubMed - as supplied by publisher]

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