Ameliorating motor performance and quality of life in Parkinson's disease: a comparison of deep brain stimulation and focused ultrasound surgery.

Introduction: Deep brain stimulation (DBS) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) have emerged as valuable treatment options for Parkinson's disease (PD) with drug-resistant symptoms. However, comparative studies of various DBS targets and MRgFUS are still limited. Methods: We reviewed three databases for trials on the effects of DBS or MRgFUS on PD patients, focusing on motor performance and quality of life (QoL). A frequentist network meta-analysis was conducted to estimate the treatment effects. Results: There were 39 trials in this study, comprising 3,002 patients. In the off-phase, subthalamic nucleus_DBS (STN_DBS [SMD, -0.94; 95%CI, -1.40 to -0.48]) significantly improved the UPDRS-III Total score compared to medication treatment alone (MT). In the on-phase, STN_DBS (SMD, -0.83; 95%CI, -1.13 to -0.53), internal globus pallidus_DBS (GPi_DBS [SMD, -0.80; 95%CI, -1.20 to -0.40]), and STN_Focused Ultrasound (STN_FUS [SMD, -1.83; 95%CI, -2.97 to -0.68]) significantly improved the UPDRS-III Total score. Regarding QoL, STN_DBS (SMD, -0.75; 95% CI, -1.46 to -0.05) and GPi_DBS (SMD, -0.58; 95% CI, -0.96 to -0.21) demonstrated better outcomes compared to MT. The SUCRA plot indicated that the top three treatments for UPDRS-III Total score in the off-phase were STN_FUS (79.6%), STN-GPi_DBS (73.7%), and STN_DBS (69.1%). In the on-phase, the top three treatments were STN_FUS (95.7%), STN_DBS (69.6%), and GPi_DBS (66.9%). Regarding QoL, GPi_DBS (77.2%) ranks first, followed by STN_DBS (67.3%), STN_FUS (56.9%) ranks third. Conclusion: STN_DBS, GPi_DBS, and STN_FUS have exhibited efficacy in ameliorating motor performance and enhancing QoL in PD patients. Nevertheless, as a potential alternative to STN_DBS with comparable efficacy, STN-FUS may serve as another treatment option.