Long-Term Quality of Life Trend after Subthalamic Stimulation for Parkinson's Disease: An Updated Systematic Review and Meta-Analysis.

Abstract

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a well-established treatment for Parkinson's Disease (PD). However, the long-term trajectory of Quality of Life (QoL) following STN-DBS remains underexplored.

Objectives: We aimed to conduct a systematic review and meta-analysis to assess QoL trends up to five years after STN-DBS.

Methods: We systematically searched PubMed, Embase, and Cochrane databases from inception to August 2024 for studies involving PD patients treated with bilateral STN-DBS, evaluating QoL using the Parkinson's Disease Questionnaire (PDQ), with a minimum follow-up of 12 months post-surgery. Continuous outcomes were pooled using standardized mean differences (SMD), and statistical analyses were conducted using R version 4.3.2.

Results: Out of 4106 screened articles, 42 studies with a total of 2767 patients were included in the meta-analysis. QoL improvements were observed up to 36 months post-surgery (SMD 0.83; 95% CI 0.29 to 1.37), followed by a decline to pre-operative levels at 60 months (SMD -0.06; 95% CI -0.26 to 0.15). Subdomain analysis at 60 months revealed significant deterioration in cognitive function and communication. Meta-regression indicated that QoL improvements were independent of clinical and sociodemographic factors such as age, sex, and disease duration; however, there was a correlation with mean baseline PDQ (P = 0.01).

Conclusions: This meta-analysis provides long-term QoL trends following STN-DBS, highlighting a further need to explore the factors driving the decline in QoL and develop strategies to mitigate this deterioration.