Early Use of 60 Hz Frequency Subthalamic Stimulation in Parkinson’s Disease: A Case Series and Review

Ramdhani, Ritesh A.; Patel, Amar; Swope, David; Kopell, Brian H.

doi:10.1111/ner.12288

Cited by 44 publications

(51 citation statements)

References 33 publications

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“…FOG at HFS seems to have the most consistent response to LFS so far, as almost all of the studies with patients exhibiting FOG at HFS on exam during the study showed a good response to LFS [4–8, 10], regardless of medication Off [4–6] or On state [6, 7, 10], and with [4, 5, 8] or without adjusting the TEED [6–8]. Some with FOG in history (medication Off) but not necessarily on exam (medication On) during the study also had good or some response to LFS [9, 16].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Ramdhani et al retrospectively studied 5 patients, all of whom had Off medication FOG and 3 of whom also had concurrent medication refractory FOG before the surgery [10]. Their FOG and axial symptoms worsened on HFS (130-185 Hz) of bilateral STN so they were subsequently switched to LFS (60 Hz) within an average of only 2 months after their DBS surgery.…”

Section: Lfs (60 Hz) Versus Hfs (130 Hz) In Patients With Fogmentioning

confidence: 99%

“…unable to stay on LFS due to worsening of tremor, gait, and rigidity)Not mentioned but voltage increased in 7 ptsF/U: overall, improvements in speech, falling and walking in UPDRS-II and speech and gait in UPDRS-III subscores but worsening of postural stability and gait in 2 pts.[6]Xie et al, 20122Non-randomized non-blindedBothYes60 Hz/130 Hz10 monthsNoAcutely: improvements in UPDRS-III score, FOG and speech at LFS at medication Off and On state. F/U: the beneficial effects lasted for 10 months of the study period.[10]Ramdhani et al, 20155Non-randomized non-blindedOnYes (4/5)60 Hz/130–185 Hz2–6 monthsNot mentionedF/U: at HFS 4/5 had FOG while at LFS only 2/5 pts. had FOG, with reduced severity and axial symptoms, along with amelioration of segmental symptoms and levodopa induced dyskinesia.…”

Section: Lfs Versus Hfs On Swallowing Functionmentioning

confidence: 99%

“…Low frequency stimulation (LFS, most commonly 60 Hz), compared to HFS (most commonly 130 Hz), has been shown to have beneficial effects on improving FOG and other axial symptoms, such as speech and swallowing function, in PD patients with bilateral STN DBS in some studies [4–10], or selected patients [11], but not in others [12–15]. Some found short-term but not long-term beneficial effect [16], while others found both short-term and long-term benefits after 6 weeks, 8 months and even 10 months study periods [4, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review

Xie

Padmanaban

Bloom

et al. 2017

Transl Neurodegener

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Some studies have shown that low frequency stimulation (LFS, most commonly 60 Hz), compared to high frequency stimulation (HFS, most commonly 130 Hz), has beneficial effects, short-term or even long-term, on improving freezing of gait (FOG) and other axial symptoms, including speech and swallowing function, in Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN DBS). However, other studies failed to confirm this. It seems not clear what determines the difference in response to LFS. Differences in study design, such as presence or absence of FOG, exact LFS used (60 Hz versus 80 Hz), study size, open label versus randomized double blind assessment, retrospective versus prospective evaluation, medication On or Off state, total electric energy delivered maintained or not with the change in frequency, and the location of active contacts could all potentially affect the results. This mini-review goes over the literature with the aforementioned factors in mind, focusing on the effect of LFS versus HFS on FOG and other axial symptoms in PD with bilateral STN DBS, in an effort to extract the essential data to guide our clinical management of axial symptoms and explore the potential underlying mechanisms as well. Overall, LFS of 60 Hz seems to be consistently effective in patients with FOG at the usual HFS in regards to improving FOG, speech, swallowing function and other axial symptoms, though LFS could reduce tremor control in some patients. Whether LFS simply addresses the axial symptoms in the context of HFS or has other beneficial effects requires further studies, along with the mechanism.

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Section: Discussionmentioning

confidence: 99%

Section: Lfs (60 Hz) Versus Hfs (130 Hz) In Patients With Fogmentioning

confidence: 99%

Section: Lfs Versus Hfs On Swallowing Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review

Xie

Padmanaban

Bloom

et al. 2017

Transl Neurodegener

View full text Add to dashboard Cite

show abstract

“…For example, improved swallow function, reduced aspiration, and fewer episodes of freezing gait were reported with low frequency (60 Hz) STN-DBS compared with high frequency (130 Hz) STN-DBS. [182231] Newer targets, such as the pedunculopontine nucleus (PPN) have shown improvements in axial signs including gait and postural stability. [1726] Sitti et al .…”

Section: Discussionmentioning

confidence: 99%

Effects of deep brain stimulation on vocal fold immobility in Parkinson's disease

Arocho-Quinones¹,

Hammer²,

Bock³

et al. 2017

Surg Neurol Int

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Background:Vocal fold (VF) immobility is a rare, potentially fatal complication of advanced Parkinson's disease (PD). Previous reports suggest that subthalamic nucleus deep brain stimulation (STN-DBS) may influence laryngeal function, yet the role of STN-DBS on VF immobility remains unexplored.Case Description:We report a case of a patient with advanced PD and bilateral VF immobility ultimately requiring a tracheostomy. To assess the effects of STN-DBS on vocal cord function and to correlate these effects with peripheral motor symptoms at different stimulation settings, the patient was evaluated before and after initiation of bilateral STN-DBS. Measures included direct observation of VF mobility via transnasal laryngoscopy, levodopa equivalent dose of anti-PD medication, and motor scores. High frequency (150 Hz) STN-DBS resulted in improved motor scores, reduced medication requirement, and modestly improved right VF abduction although insufficient for safe decannulation. Low frequency (60 Hz) stimulation resulted in lower motor scores, but without worsening VF abduction.Conclusions:STN-DBS may play an important role in the neuromodulation of PD-induced laryngeal dysfunction, including VF mobility. Characterization of these axial symptoms is important when programming and evaluating responsiveness to DBS.

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Effects of Subthalamic Nucleus Deep Brain Stimulation on Objective Sleep Outcomes in Parkinson's Disease

Amara

Walker

Joop

et al. 2016

Movement Disord Clin Pract

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Background Sleep dysfunction is a common and disabling non-motor symptom in Parkinson’s disease. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms and subjective sleep in PD, but alternative stimulation parameters to optimize sleep have not been explored. We hypothesized that low frequency STN DBS would improve objective sleep more than conventional settings. Methods Twenty PD subjects with STN DBS (18 unilateral, 2 bilateral) underwent 3 non-consecutive nights of polysomnography: DBS off; DBS high frequency (≥130 Hz); and DBS low frequency (60 Hz). Motor symptom tolerability was assessed 30 minutes after resumption of baseline settings the morning following polysomnography. The primary outcome was change in sleep efficiency between high and low frequency nights measured with repeated measures ANOVA. Results There was no difference in sleep efficiency between nights at high frequency (82.1% (72.6–90.1)) (median (IQR)), low frequency (81.2% (56.2–88.8)), or DBS off (82.8% (75.7–87.4)), p=0.241. Additionally, there was no difference in sleep stage percent, arousals, limb movements, subjective sleep quality, or objective vigilance measures. These outcomes did not change after adjusting for age, sex, disease duration, or side of surgery. No residual adverse motor effects were noted. Conclusions Although well tolerated, low frequency STN DBS did not improve objective sleep in PD. Remarkably, objective measures of sleep were not worse with DBS off. These observations point to the potential for adaptive stimulation approaches, through which DBS settings could be optimized during sleep to meet individual needs. Additionally, these changes could preserve battery life without compromising patient outcomes.

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Early Use of 60 Hz Frequency Subthalamic Stimulation in Parkinson’s Disease: A Case Series and Review

Cited by 44 publications

References 33 publications

Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review

Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review

Effects of deep brain stimulation on vocal fold immobility in Parkinson's disease

Effects of Subthalamic Nucleus Deep Brain Stimulation on Objective Sleep Outcomes in Parkinson's Disease

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