Meta-analysis: STN DBS yields similar motor benefit in monogenic PD

  • Artusi CA & al.
  • JAMA Netw Open
  • 01.02.2019

  • von Susan London
  • Clinical Essentials
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Takeaway

  • Compared with peers having idiopathic Parkinson's disease (PD), patients with monogenic PD see similar motor improvement with subthalamic nucleus deep brain stimulation (STN DBS), but other outcomes differ somewhat.

Why this matters

Key results

  • Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) score improvement:
    • 46% in LRRK2 (mean change, 23.0 points; P<.001>
    • 49% in GBA (20.0 points; P=.01).
    • 43% in PRKN (24.1 points; P<.001>
    • 53% in idiopathic PD (25.2 points; P<.001>
  • Levodopa equivalent daily dose reduction:
    • 61% in LRRK2 (mean change, 711.9 mg/day; P<.001>
    • 22% in GBA (269.2 mg/day; P<.001>
    • 61% in PRKN (494.8 mg/day; P=.06).
    • 55% in idiopathic PD (681.8 mg/day; P<.001>
  • Other outcomes:
    • PRKN: sustained improvements in UPDRS-II and UPDRS-IV.
    • LRRK2: sustained improvements in only UPDRS-IV.
    • GBA: poorer postsurgical cognitive, functional outcome.

Study design

  • Systematic review, meta-analysis of 17 studies of 518 patients with PD (26.1% monogenic) undergoing STN DBS treatment:
    • 8 cohort studies.
    • 3 case series.
    • 6 case reports.
  • Main outcome: changes in Motor subscale UPDRS-III score, levodopa equivalent daily dose.
  • Funding: None disclosed.

Limitations

  • Heterogeneity of studies.
  • Small sample for monogenic PD.
  • Meta-analysis not possible for many outcomes.
  • Factors affecting outcomes cosegregate with monogenic disease.