Editing Deep brain stimulation (section)

=====Short term comparisons=====
An indirect systems analysis compared the DBS to the STN, DBS of the GPi, subthalamotomy, jejunal levodopa, and subcutaneous apomorphine, in the first 6 months. Different results were seen depending on dopamine responsivity and whether motor symptoms (UPDRS II) or activities of daily living (UPDRS III) were assessed:<ref name = "AIIMS meta analysis 2022"/>

{| class="wikitable"
|+
!Symptom
!Dopamine responsivity
!Most effective therapy
!Patient preference (%)
|-
|Motor symptoms (UPDRS III)
|Dopamine unresponsive ''off state''
|Unilateral STN + contralateral subthalamotomy > Bilateral STN DBS > unilateral subthalamotomy > Bilateral GPi DBS
|90% / 70% / 65% / 55%
|-
|Motor symptoms (UPDRS III)
|Dopamine responsive ''on state''
|GPI = unilateral subthalamotomy + STN > jejunal levodopa
|80% / 80% / 80%
|-
|Activities of daily living (UPDRS II)
|Dopamine unresponsive ''off state''
|Unilateral STN + contralateral subthalamotomy > STN DBS > GPi DBS
|90% / 70% / 64%
|-
|Activities of daily living (UPDRS II)
|Dopamine responsive ''on state''
|Jejunal levodopa > STN DBS > unilateral pallidotomy
|90% / 50% / 66%
|}

A Bayesian analysis utilizing the minimal clinically important difference (MCID) compared DBS (predominantly of the STN and to a lesser degree GPi) to infusions of intestinal dopamine, apomorphine, and medical therapy. The analysis was significantly limited because it followed dopamine prospectively only to 3 months but other therapies such as DBS to five years. There was also a 10-fold difference in the quantity of DBS patients as compared to other therapies. They found LCIG to be similar to DBS, though with a wider confidence interval for dopamine due to lower quantity of participants. In the non-prospective cohort groups, LCIG lost its benefit for activities of daily living after 2–3 years. Both therapies were superior to apomorphine and best medical therapy for activities of daily living and "on" time for dopamine responsiveness, while DBS had the highest rate of adverse effects, particularly surgical and neuropsychiatric. LCIG was similar to DBS in effect on quality of life, though the analysis for levodopa was again underpowered.<ref name="Nijhuis MID 2021">{{cite journal |last1=Nijhuis |first1=FAP |last2=Esselink |first2=R |last3=de Bie |first3=RMA |last4=Groenewoud |first4=H |last5=Bloem |first5=BR |last6=Post |first6=B |last7=Meinders |first7=MJ |title=Translating Evidence to Advanced Parkinson's Disease Patients: A Systematic Review and Meta-Analysis. |journal=Movement Disorders |date=June 2021 |volume=36 |issue=6 |pages=1293–1307 |doi=10.1002/mds.28599 |pmid=33797786|pmc=8252410 }}</ref>

A short term meta-analysis that primarily looked at changes within the first year found the STN to be better than the GPi for motor symptoms and activities of daily living, but they included studies that analyzed the targets separately. For activities of daily living (UPDRS II) with DBS during the dopamine unresponsive state, patients improved 50% with STN but only 20% with GPi. For motor symptoms (UPDRS III), there was a 50% with STN but only 30% with GPi-DBS. STN reduced dyskinesia by 64%, OFF time by 69%, improved QOL by 20%, Levodopa dose was reduced 50%. GPi insufficient data to assess for dyskinesia OFF time, and levodopa reduction.<ref name="Nature 2021">{{cite journal |last1=Lachenmayer |first1=ML |last2=Mürset |first2=M |title=Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes. |journal=npj Parkinson's Disease |date=6 September 2021 |volume=7 |issue=1 |page=77 |doi=10.1038/s41531-021-00223-5 |pmid=34489472|pmc=8421387 }}</ref>

A meta analysis following 1148 patients for a year and with an equal distribution between groups found that both STN and GPi improved motor function, but in different ways. GPi preserved postural instability and gait disability better than STN. GPi did not produce any significant improvement over STN in motor symptoms during the on state, though a point estimate favored the use of GPi. Motor symptoms in the off state showed that STN did not produce any significant improvement over GPi, though again a point estimate favored the use of STN. STN had a larger dopamine reduction than GPi, while GPi improved depression more than STN after surgery. Compared to the GPi, the STN showed more improvement in off state motor symptoms and activities of daily living. Conversely, the GPi was better than the STN for on state motor symptoms and activities of daily living,<ref>{{cite journal |last1=Xu |first1=F |last2=Ma |first2=W |title=Deep brain stimulation of pallidal versus subthalamic for patients with Parkinson's disease: a meta-analysis of controlled clinical trials. |journal=Neuropsychiatric Disease and Treatment |date=2016 |volume=12 |pages=1435–44 |doi=10.2147/NDT.S105513 |doi-access=free |pmid=27382286|pmc=4922776 }}</ref> similar to data from the Netherlands NSTAPS study.<ref>{{cite journal |last1=Odekerken |first1=VJ |last2=de Bie |first2=RM |title=Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. |journal=The Lancet. Neurology |date=January 2013 |volume=12 |issue=1 |pages=37–44 |doi=10.1016/S1474-4422(12)70264-8 |pmid=23168021}}</ref>