A Meta-Analysis of the Effect of Subthalamic Nucleus-Deep Brain Stimulation in Parkinson's Disease-Related Pain

Abstract

Pain from Parkinson's disease (PD) is a non-motor symptom affecting the quality of life and has prevalence of 20–80%. However, it is unclear whether subthalamic nucleus deep brain stimulation (STN–DBS), a well-established treatment for PD, is effective forPD-related pain. Thus, the objective of this meta-analysis was to investigate the efficacy of STN-DBS on PD-related pain and explore how its duration affects the efficacy of STN-DBS. A systematic search was performed using PubMed, Embase, and the Cochrane Library. Nine studies included numerical rating scale (NRS), visual analog scale (VAS), or non-motor symptom scale (NMSS) scores at baseline and at the last follow-up visit and therefore met the inclusion criteria of the authors. These studies exhibited moderate- to high-quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. Random effect meta-analysis revealed a significant change in PD-related pain as assessed by NMSS, NRS, and VAS (P <0.01). Analysis of the short and long follow-up subgroups indicated delayed improvement in PD-related pain. These findings (a) show the efficacy of STN-DBS on PD-related pain and provide higher-level evidence, and (b) implicate delayed improvement in PD-related pain, which may help programming doctors with supplement selecting target and programming.Systematic Review Registration: This study is registered in Open Science Framework (DOI: 10.17605/OSF.IO/DNM6K).

A nigro–subthalamo–parabrachial pathway modulates pain-like behaviors

“…Optogenetic activation of STN neurons decreases pain thresholds in mice 20 . Consistent with previous studies showing that deep brain stimulation (DBS) in the STN relieves pain in patients with Parkinson's disease [27][28][29][30][31][32][33] , we demonstrated that optogenetic inhibition of hyperactive STN neurons ameliorates hyperalgesia and central sensitization in parkinsonian mice 20 . The STN sends glutamatergic projections to both basal ganglia and non-basal ganglia structures 21,23 .…”

Effects of Subthalamic Nucleus Deep Brain Stimulation on Depression in Patients with Parkinson’s Disease

“…Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor symptoms (tremor, rigidity, and slowness of movements) and several non-motor symptoms [ 1 , 2 , 3 , 4 ]. Depression, one of the most common non-motor symptoms, is a chronic and commonly reported neuropsychiatric disorder that occurs in 40%–50% of patients with PD [ 5 , 6 ].…”

Premature drug reduction after subthalamic nucleus deep brain stimulation leading to worse depression in patients with Parkinson's disease

“…Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is the first-line surgical treatment for Parkinson's disease (PD), it can effectively improve Parkinson's disease patients' motor and non-motor symptoms (1,2), reduce motor fluctuations, reduce dopaminergic drug use and adverse drug reactions, and improve patients' quality of life (3)(4)(5). In recent years, an increasing number of studies have discovered that non-motor symptoms, particularly emotional aspects such as anxiety and depression, have a significant impact on the quality of life of Parkinson's disease patients (6).…”