Superiority of dual-target STN-SNr deep brain stimulation towards gait in Parkinson's disease: a meta-analysis and meta-regression of randomised trials.
8 affiliations
- 1Medical Doctor Profession Program, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.
- 2Department of Physiology, Biochemistry and Biomolecular, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.
- 3Department of Microbiology and Parasitology, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.
- 4Medical Education Study Program, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia.
- 5Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia.
- 6Department of Neurology, RSUD Dr H Abdul Moeloek Hospital, Bandar Lampung, Indonesia.
- 7Department of Neurosurgery, RSUD Dr H Abdul Moeloek Hospital, Bandar Lampung, Indonesia.
- 8Gadjah Mada University Faculty of Medicine Public Health and Nursing, Yogyakarta, Indonesia.
Abstract
Objectives
To 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
Systematic review and meta-analysis of crossover randomised controlled trials (RCTs).Setting
A systematic search was conducted across PubMed, ScienceDirect and Scopus databases up to October 2025.Participants
Adults 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
Dual-target DBS stimulation of the STN and SNr compared with conventional STN-only stimulation.Main outcome measures
FoG and QoL.Results
Eight 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
Combined 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
CRD42025632066.
Related
- Intensification of blood pressure lowering therapeutics based on diuretics versus usual management for uncontrolled hypertension in patients with moderate to severe chronic kidney disease (THINK): protocol for an open label, two-parallel group, cluster randomised controlled, superiority, phase 3 trial
- Transcutaneous auricular vagus nerve stimulation demonstrates effects on pupil responses in Parkinson's disease
- Incidental Finding of an Asymptomatic Perielectrode Cyst After Deep Brain Stimulation for Parkinson’s Disease
- Effects of globus pallidus internus deep brain stimulation on freezing of gait in Parkinson's disease: a prospective short-term single-arm study
- Disease Duration Differentiates Freezing of Gait Response to Subthalamic and Nigral Stimulation for Parkinson's Disease in an Exploratory Multicenter Controlled Trial
BibTeX
@article{haq2026superiority,
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.}},
author = {Rais Amaral Haq and Khairun Nisa Berawi and Suryadi Islami and Jihan Siti Muthmainah and Gasela Zalianti Balqis and Adi Sulistyanto and Alfi Rizky Medikanto and Ryan Rhiveldi Keswani and Muhammad Yunus and Artha Simanjuntak and Frengki Prabowo Saputro Wijayanto},
journal = {BMJ connections. Surgery},
year = {2026},
month = jun,
doi = {10.1136/bmjcsurg-2026-000033},
url = {https://europepmc.org/article/MED/42968793},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Superiority of dual-target STN-SNr deep brain stimulation towards gait in Parkinson's disease: a meta-analysis and meta-regression of randomised trials.
AU - Rais Amaral Haq
AU - Khairun Nisa Berawi
AU - Suryadi Islami
AU - Jihan Siti Muthmainah
AU - Gasela Zalianti Balqis
AU - Adi Sulistyanto
AU - Alfi Rizky Medikanto
AU - Ryan Rhiveldi Keswani
AU - Muhammad Yunus
AU - Artha Simanjuntak
AU - Frengki Prabowo Saputro Wijayanto
PY - 2026
DA - 2026/06/15
JO - BMJ connections. Surgery
DO - 10.1136/bmjcsurg-2026-000033
UR - https://europepmc.org/article/MED/42968793
AB - Objectives To 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 Systematic review and meta-analysis of crossover randomised controlled trials (RCTs).Setting A systematic search was conducted across PubMed, ScienceDirect and Scopus databases up to October 2025.Participants Adults 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 Dual-target DBS stimulation of the STN and SNr compared with conventional STN-only stimulation.Main outcome measures FoG and QoL.Results Eight 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 Combined 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 CRD42025632066.
SN - 2978-1809
ER -