• Yi-Song Wu, Lin-Hui Ni, Ru-Meng Fan, and Ming-Yang Yao.
• Department of Neurology, Xinyang Central Hospital, Xinyang, China. Electronic address: WuYS-neuro@outlook.com.
• World Neurosurg. 2019 Sep 1; 129: e409-e416.

ObjectiveThe globus pallidus internus (GPi) and subthalamic nucleus (STN) are therapeutic targets for deep brain stimulation (DBS) in the treatment of isolated dystonia. We conducted a meta-regression analysis on long-term studies of bilateral DBS in the GPi and STN to compare the relative effects of the 2 approaches.MethodsWe systematically searched the PubMed, Embase, and Cochrane Controlled Register of Trials databases to identify studies reporting the treatment outcomes of GPi DBS and STN DBS for isolated dystonia. The primary outcome measure was the change in the Burke-Fahn-Marsden dystonia rating scale movement score between the baseline and follow-up evaluations. We performed a regression analysis using a random effects model.ResultsA total of 42 follow-up evaluations (30 for GPi and 12 for STN) nested in 19 studies (16 of GPi and 3 of STN) were included in our analysis. The results from univariate regression analysis suggested that shorter disease duration and STN stimulation were associated with a greater standardized change in the Burke-Fahn-Marsden dystonia rating scale movement score. On combining the factors into 1 model, only the disease duration remained significant. The regression analysis results of the GPi and STN subgroups revealed more persistent improvement after STN stimulation.ConclusionsA shorter disease duration correlated positively with better DBS outcomes. The STN appeared to be an optimized stimulation target for the treatment of isolated dystonia, although randomized controlled trials are needed to compare the treatment efficacy of GPi DBS and STN DBS.Copyright © 2019 Elsevier Inc. All rights reserved.

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