Introduction: While subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa improve motor symptoms in Parkinson disease (PD) to a similar magnitude, their combined effect remains unclear. We sought to evaluate whether STN-DBS and levodopa yield differential effects on motor outcomes, dyskinesia, and activities of daily living (ADL) when combined compared to when administered alone.
Methods: We conducted a meta-analysis of all studies reporting motor, dyskinesia, and ADL outcomes after bilateral STN-DBS in PD with presurgical Unified Parkinson's Disease Rating Scale (UPDRS-III) in Medication-OFF and Medication-ON states and postsurgical assessments in four conditions: Stimulation-ON/Medication-ON, Stimulation-ON/Medication-OFF, Stimulation-OFF/Medication-ON, and Stimulation-OFF/Medication-OFF. Dyskinesia duration (UPDRS item 32) and ADL (UPDRS-II) were compared between high and low postsurgical levodopa equivalent daily dose (LEDD) reduction. Random-effects meta-analyses using generic-inverse variance were conducted. Confidence in outcomes effect sizes was assessed.
Results: Twelve studies were included (n = 401 patients). Stimulation-ON/Medication-ON was associated with an UPDRS-III improvement of - 35.7 points [95% confidence interval, - 40.4, - 31.0] compared with Stimulation-OFF/Medication-OFF, - 11.2 points [- 14.0, - 8.4] compared with Stimulation-OFF/Medication-ON, and - 9.5 points [- 11.0, - 8.0] compared to Stimulation-ON/Medication-OFF within 5 years. The difference was maintained beyond 5 years by - 28.6 [- 32.8, - 24.4], - 8.1 [- 10.2, - 5.9], and - 8.0 [- 10.3, - 5.6], respectively. No difference was observed between Stimulation-ON/Medication-OFF and Stimulation-OFF/Medication-ON within and beyond 5 years. Dyskinesia duration and ADL outcomes were similar in high vs. low postsurgical LEDD reduction.
Conclusion: Subthalamic nucleus deep brain stimulation and levodopa independently lessened motor severity in PD to a similar magnitude, but their combined effect was greater than either treatment alone, suggesting therapeutic synergism.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00415-018-8936-2 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The canonical deep neural network as a model for human symmetry processing.
iScience
January 2025
Division of Optometry, Health Sciences, City University of London, London EC1V 0HB, UK.
A key property of our environment is the mirror symmetry of many objects, although symmetry is an abstract global property with no definable shape template, making symmetry identification a challenge for standard template-matching algorithms. We therefore ask whether Deep Neural Networks (DNNs) trained on typical natural environmental images develop a selectivity for symmetry similar to that of the human brain. We tested a DNN trained on such typical natural images with object-free random-dot images of 1, 2, and 4 symmetry axes.
View Article and Find Full Text PDFAdvancements in Neurotechnology: Pioneering Brain Monitoring and Stimulation for Enhanced Treatment and Understanding.
ACS Med Chem Lett
January 2025
Usona Institute, Fitchburg, Wisconsin 53711-5300, United States.
This Patent Highlight explores recent innovations in neuroscience and neurotechnology, particularly in brain monitoring and stimulation. It examines four essential patents: novel psychoplastogens for neuronal growth, techniques for transferring emotional states, and advanced systems for self-guided neural diagnostics and treatment. The discussion extends to deep brain stimulation (DBS) for motor and memory disorders, enhanced brain function monitoring through electroencephalography (EEG), and the role of artificial intelligence in personalizing treatment strategies.
View Article and Find Full Text PDFMultimodal fluorescence-optoacoustic imaging of the near-infrared calcium ion indicator NIR-GECO2G.
Photoacoustics
February 2025
NYU Langone Health, Tech4Health and Neuroscience Institutes, and Department of Ophthalmology, New York City, USA.
Measuring whole-brain distributed functional activity is an important unmet need in neuroscience, requiring high temporal resolution and cellular specificity across large volumes. Functional optoacoustic neuro-tomography (FONT) with genetically encoded calcium ion indicators is a promising approach towards this goal. However, it has not yet been applied in the near-infrared (NIR) range that provides deep penetration and low vascular background optimal for neuroimaging.
View Article and Find Full Text PDFRecommendations for the Safe Application of Temporal Interference Stimulation in the Human Brain Part II: Biophysics, Dosimetry, and Safety Recommendations.
Bioelectromagnetics
January 2025
Foundation for Research on Information Technologies in Society, Zurich, Switzerland.
Temporal interference stimulation (TIS) is a new form of transcranial electrical stimulation (tES) that has been proposed as a method for targeted, noninvasive stimulation of deep brain structures. While TIS holds promise for a variety of clinical and nonclinical applications, little data is yet available regarding its effects in humans and its mechanisms of action. To inform the design and safe conduct of experiments involving TIS, researchers require quantitative guidance regarding safe exposure limits and other safety considerations.
View Article and Find Full Text PDFDiagnosis of Parkinson's disease by eliciting trait-specific eye movements in multi-visual tasks.
J Transl Med
January 2025
School of Information and Communication Engineering, Dalian University of Technology, No. 2 Linggong Road, 116024, Dalian, China.
Background: Parkinson's Disease (PD) is a neurodegenerative disorder, and eye movement abnormalities are a significant symptom of its diagnosis. In this paper, we developed a multi-task driven by eye movement in a virtual reality (VR) environment to elicit PD-specific eye movement abnormalities. The abnormal features were subsequently modeled by using the proposed deep learning algorithm to achieve an auxiliary diagnosis of PD.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!