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Deep brain stimulation improves gait velocity in Parkinson’s disease: a systematic review and meta-analysis

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Abstract

In Parkinson’s disease (PD), slow gait speed is significantly related to clinical ratings of disease severity, impaired performance of daily activities, as well as increased overall disability. Conducting a meta-analysis on gait speed is an objective and quantitative technique to summarize the effectiveness of DBS and to determine the effect sizes for future studies. We conducted a systematic review and meta-analysis that analyzed the effects of deep brain stimulation (DBS) surgery on gait speed in patients with PD to gain fundamental insight into the nature of therapeutic effectiveness. A random effects model meta-analysis on 27 studies revealed a significant overall standardized mean difference medium effect size equal to 0.60 (SE = 0.06; p < 0.0001; Z = 10.58). Based on our synthesis of the 27 studies, we determined the following: (1) a significant and medium effect size indicating DBS improves gait speed; (2) DBS improved gait speed regardless of whether the patients were tested in the on or off medication state; (3) both bilateral and unilateral DBS led to gait speed improvement; (4) the effects of DBS on gait speed in the data collection sessions after surgery (DBS on vs. off) were comparable with data collection before surgery (before surgery vs. DBS after surgery); and (5) when evaluating the effects of DBS and medication on gait speed suprathreshold doses were comparable to normal dosages of medication and DBS. The current analysis provides objective evidence that both unilateral and bilateral DBS provide a therapeutic benefit on gait speed in persons with PD.

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Authors and Affiliations

  1. Department of Applied Physiology and Kinesiology, University of Florida, 100 Florida Gym, PO Box 118205, Gainesville, FL, 32611-8205, USA

    Jaimie A. Roper, Nyeonju Kang, Juliana Ben, James H. Cauraugh & Chris J. Hass

  2. Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, USA

    Jaimie A. Roper, Juliana Ben, Michael S. Okun & Chris J. Hass

  3. Department of Neurology, University of Florida, Gainesville, USA

    Michael S. Okun

  4. Department of Neurosurgery, University of Florida, Gainesville, USA

    Michael S. Okun

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  1. Jaimie A. Roper
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  2. Nyeonju Kang
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  3. Juliana Ben
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Correspondence to Jaimie A. Roper.

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Full financial disclosure for the past 12 months: JAR, NK, JB, JHC, and CJH do not have any disclosures. MSO serves as a consultant for the National Parkinson Foundation, and has received research Grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun has previously received honoraria, but in the past >60 months has received no support from industry. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME and educational activities on movement disorders (in the last 36) months sponsored by PeerView, Prime, Quantia, Henry Stewart, and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic, Abbvie, and ANS/St. Jude, and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria.

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Roper, J.A., Kang, N., Ben, J. et al. Deep brain stimulation improves gait velocity in Parkinson’s disease: a systematic review and meta-analysis. J Neurol 263, 1195–1203 (2016). https://doi.org/10.1007/s00415-016-8129-9

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