Burst deep brain stimulation for Parkinson's disease: A systematic review of efficacy and safety

Abstract

Background Burst deep brain stimulation (DBS) is a promising alternative to conventional deep brain stimulation (cDBS), incorporating paradigms such as theta burst stimulation (TBS), burst cycling (BC), and coordinated reset (CR). Findings from transcranial magnetic stimulation, spinal cord stimulation and focused ultrasound neuromodulation inspire its potential application in Parkinson's disease (PD). Objective This review evaluates the evidence on the efficacy and safety of burst DBS in PD. Methods A systematic literature search was conducted in PubMed, Embase, and Web of Science. Inclusion criteria encompassed peer-reviewed primary preclinical or clinical studies in English, reporting motor outcomes and burst stimulation parameters. Methodological quality was assessed using SYRCLE and a modified Newcastle-Ottawa Scale. Data extraction was performed systematically, and findings were synthesized narratively. Results 19 studies met inclusion criteria: nine preclinical and ten clinical studies. Eight focused on BC (three including safety), four examined TBS (two including safety), and seven addressed CR (one including safety). Burst DBS showed mostly similar acute efficacy to cDBS, with distinct post-stimulation effects. No major adverse events were reported. However, stimulation settings varied widely, with no consensus on optimal parameters. Conclusion Efficacy and safety of burst DBS appear to be comparable to cDBS, with potential benefits such as post-stimulation effects. However, the risk of bias, variability in stimulation settings, inconsistent terminology, and other methodological considerations limit the interpretation of previous research. Further randomized studies are crucial to better refine the stimulation parameters and establish standardized clinical protocols that can be used to compare burst DBS with cDBS.