# Deep Brain Stimulation for Post‐Stroke Movement Disorders of Various Etiologies: An Individual Participant Data (IPD) Meta‐Analysis

## TL;DR

Deep brain stimulation can help treat movement disorders after stroke, but more research is needed to determine the best treatment approaches.

## Contribution

This study provides a meta-analysis of individual patient data to evaluate the effectiveness of different deep brain stimulation targets for post-stroke movement disorders.

## Key findings

- GPi-DBS improved dystonia symptoms more than VIM or combined GPi/VIM stimulation.
- No significant correlations were found between DBS outcomes and patient demographics or stimulation parameters.
- Adverse events occurred in 19% of cases, highlighting the need for careful patient selection.

## Abstract

Post‐stroke movement disorders consisting of complex involuntary movement patterns with parkinsonism, dystonia, hemiballismus/hemichorea, and tremor represent a therapeutical challenge. Deep brain stimulation has been considered an effective treatment option, although it remains unclear which DBS targets should be approached.

An individual participant data meta‐analysis was conducted analyzing the efficacy (Burke Fahn Marsden Dystonia Rating Scale (BFM)‐motor/‐disability and the Fahn‐Tolosa‐Marín Scale for tremor (FTMTRS)) of pallidal (GPi) deep brain stimulation versus thalamic (VIM) versus GPi + VIM. PubMed, Embase, Cochrane Library, Ovid Medline, and Scopus were searched from 2000 to 2025. Additionally, correlation/regression analyses (age, duration of disease, stimulation parameters) were performed.

Sixteen studies including 32 patients (34.4% male; 65.6% female) were enrolled targeting the GPi (63.2%) versus VIM (23.6%) versus GPi/VIM‐DBS (13.2%). Dystonia with tremor was found in 53%, dystonia with hemichorea/choreoathetosis in 50% (age at disease onset: 10 ± 18 years, age at DBS surgery: 37 ± 15 years, disease duration: 28 ± 19 years). GPi‐DBS improved dystonia (BFM‐motor: 6–12 months p < 0.005 and >12 months p = 0.038; BFM‐disability 6–12 months p = 0.038) with no significant/relevant changes for VIM and GPi/VIM. No correlations were determined between DBS outcome and stimulation protocol and demographic characteristics. Adverse events occurred in 19%.

DBS is effective for treating post‐stroke movement disorders of various etiologies. Given the heterogeneity, selection, and reporting bias, the published data is limited in providing high‐quality evidence. Hence, the authors advocate a multifocal DBS approach along with trial stimulation determined under a rigorous study protocol.

DBS is effective for treating post‐stroke movement disorders of various etiologies. Given the heterogeneity, selection, and reporting bias, the published data is limited in providing high‐quality evidence indicating the need of clinical research assessing multifocal DBS and adaptive DBS stimulation patterns under a rigorous study protocol.