{
  "abstract": "Objectives\n\nTo evaluate the effectiveness of a dual-target deep brain stimulation (DBS) approach, stimulating both the subthalamic nucleus (STN) and the substantia nigra pars reticulata (SNr), and improvement of gait function and quality of life (QoL) in patients with Parkinson's disease (PD).Design\n\nSystematic review and meta-analysis of crossover randomised controlled trials (RCTs).Setting\n\nA systematic search was conducted across PubMed, ScienceDirect and Scopus databases up to October 2025.Participants\n\nAdults with advanced PD (disease duration >5 years) experiencing clinically significant and refractory freezing of gait (FoG) despite optimal dopaminergic therapy and standard STN-DBS.Interventions\n\nDual-target DBS stimulation of the STN and SNr compared with conventional STN-only stimulation.Main outcome measures\n\nFoG and QoL.Results\n\nEight crossover RCTs (n=97) were included. Combined STN+SNr resulted in a significant reduction in FoG compared with STN stimulation alone (standard mean difference=-0.39 (95% CI -0.73 to -0.04), I²=23.2%). No significant difference was observed in QoL (mean difference=-0.79 (95% CI -1.92 to 0.34), I²=0%). Meta regression revealed high-frequency stimulation in both targets was a significant moderator for gait improvement (95% CI -0.96 to -0.05, I²=39.2%). Adverse effects were generally transient and reversible.Conclusions\n\nCombined STN and SNr stimulation provides significant clinical benefit for refractory FoG in advanced PD. However, this motor improvement did not translate into immediate QoL gains. Further investigation of RCTs and integrated rehabilitative management are essential to establish broader applicability and its long-term value.Prospero registration number\n\nCRD42025632066.",
  "abstract_shown": true,
  "affiliations": [
    "Medical Doctor Profession Program, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.",
    "Department of Physiology, Biochemistry and Biomolecular, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.",
    "Department of Microbiology and Parasitology, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.",
    "Medical Education Study Program, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.",
    "Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia.",
    "Department of Neurology, RSUD Dr H Abdul Moeloek Hospital, Bandar Lampung, Indonesia.",
    "Department of Neurosurgery, RSUD Dr H Abdul Moeloek Hospital, Bandar Lampung, Indonesia.",
    "Gadjah Mada University Faculty of Medicine Public Health and Nursing, Yogyakarta, Indonesia."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rais Amaral Haq",
      "orcid": "0009-0005-2853-4156"
    },
    {
      "affs": [
        1
      ],
      "name": "Khairun Nisa Berawi",
      "orcid": "0000-0001-5707-464X"
    },
    {
      "affs": [
        2
      ],
      "name": "Suryadi Islami",
      "orcid": "0000-0002-7345-6960"
    },
    {
      "affs": [
        3
      ],
      "name": "Jihan Siti Muthmainah",
      "orcid": "0009-0008-9223-8089"
    },
    {
      "affs": [
        0
      ],
      "name": "Gasela Zalianti Balqis",
      "orcid": "0009-0008-2019-6887"
    },
    {
      "affs": [
        4
      ],
      "name": "Adi Sulistyanto"
    },
    {
      "affs": [
        5
      ],
      "name": "Alfi Rizky Medikanto",
      "orcid": "0009-0000-9977-6455"
    },
    {
      "affs": [
        4
      ],
      "name": "Ryan Rhiveldi Keswani"
    },
    {
      "affs": [
        6
      ],
      "name": "Muhammad Yunus",
      "orcid": "0009-0005-4246-4553"
    },
    {
      "affs": [
        7
      ],
      "name": "Artha Simanjuntak"
    },
    {
      "affs": [
        7
      ],
      "name": "Frengki Prabowo Saputro Wijayanto",
      "orcid": "0009-0008-0308-6141"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5qsqhnysx13gn.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjcsurg-2026-000033",
  "fulltext_url": "https://europepmc.org/articles/PMC13723789",
  "id": "5qsqhnysx13gn",
  "issns": [
    "2978-1809"
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  "landing_url": "https://europepmc.org/article/MED/42968793",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Original Research"
    ],
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      "openalex",
      "2728|Neurological disorders and treatments"
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  "pdf_url": "https://europepmc.org/articles/PMC13723789?pdf=render",
  "pmcid": "PMC13723789",
  "pmid": "42968793",
  "published": "2026-06-15",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/5qsqhnysx13gn.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:54Z",
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      "field": "medicine",
      "origin": "openalex:2728|Neurological disorders and treatments",
      "subfield": "neurology"
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  ],
  "title": "Superiority of dual-target STN-SNr deep brain stimulation towards gait in Parkinson's disease: a meta-analysis and meta-regression of randomised trials.",
  "title_text": "Superiority of dual-target STN-SNr deep brain stimulation towards gait in Parkinson's disease: a meta-analysis and meta-regression of randomised trials.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:32Z",
  "url": "https://research.draconitic.com/paper/5qsqhnysx13gn",
  "venue": "BMJ connections. Surgery",
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}