• Yuksel Altinel, Fahad Alkhalfan, Nidan Qiao, and Marko Velimirovic.
• Medical Sciences in Clinical Investigation, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2019 Mar 1; 123: 443-452.e8.

IntroductionOptimal surgical strategy for patients with tremor remains uncertain. We conducted a systematic review and meta-analysis evaluating randomized controlled trials of deep brain stimulation (DBS) and lesion surgery (LS) in the treatment of tremor.MethodsWe searched PubMed, Embase, and the Cochrane database to include randomized clinical trials with either LS, deep brain stimulation, or controls. The outcomes were the change in tremor score, quality of life, cognitive function, and neuropsychiatric function. We used standardized mean differences (SMDs) to pool the outcomes.ResultsFifteen trials, including 1508 patients, met eligibility criteria. We observed no significant difference in change of tremor scale (SMD -0.07, 95% confidence interval [CI]: -0.38 to 0.24), quality of life (SMD -0.21, 95% CI: -0.69 to 0.27), cognitive function (SMD 0.06, 95% CI: -0.27 to 0.39), or neuropsychiatric function (SMD -0.15, 95% CI: -0.49 to 0.19) between LS and stimulation surgery. We observed heterogeneity across studies during indirect comparison of quality of life. We identified a possible effect modifier: improvement in quality of life correlated with duration of disease (P = 0.035). We found that focused-ultrasound LS was associated with a 0.70 SMD increase (P = 0.014) in quality of life versus DBS in an exploratory subgroup analysis by separating 2 studies with focused-ultrasound LS from other LS studies.ConclusionsAlthough the main analysis showed that LS and DBS were equally effective in the treatment of patients with tremor, an exploratory subgroup analysis indicated an improvement in quality of life with noninvasive focused-ultrasound surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

16 keywords...

hide…