Frequency-Dependent Reciprocal Modulation of Verbal Fluency and Motor Functions in Subthalamic Deep Brain Stimulation

Abstract

Background: High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor functions in those with Parkinson disease but may worsen frontal functions such as verbal fluency (VF). In contrast, low-frequency DBS leads to deterioration of motor functions. It is not known whether low-frequency STN DBS also has an effect on frontal functions.Objective: To examine whether low-frequency STN DBS in contrast to high-frequency STN DBS has a positive effect on frontal functions on the basis of VF test results.Design: A double-blind randomized crossover experiment to compare performance in 4 VF subtests and motor performance at 10 Hz, 130 Hz, and no stimulation.Setting: University hospitals in Dü sseldorf and Cologne, Germany.Patients: Twelve patients with Parkinson disease 3 months or more after bilateral electrode implantation into the STN.

Deep Brain Stimulation of the Globus Pallidus Internus in the Parkinsonian Primate: Local Entrainment and Suppression of Low-Frequency Oscillations

“…A causal relationship between any of these firing abnormalities and parkinsonian signs has been brought into question by recent studies, however (Boraud et al 1998;Wojtecki et al 2006). We focused on DBS-induced changes in neuronal activity that were present after 20 s of continuous stimulation because effects during this period were most relevant to the slow time course of some of the therapeutic effects of DBS (Temperli et al 2003; although minutes/hours of continuous stimulation may well reveal additional stimulation effects).…”

Expectation modulates the effect of deep brain stimulation on motor and cognitive function in tremor-dominant Parkinson's disease

“…Thus, negative expectation regarding the effect of STN-DBS on motor function did not only modulate the magnitude of resting tremor but additionally had an adverse effect on a cognitive function often affected in PD patients treated with STN-DBS [6][7][8][9]. This suggests an expectation-induced generalization of a nocebo response manifesting on motor as well as on cognitive functions.…”

“…Although both treatments generally lead to improvement in motor symptoms, tremor is usually more effectively supressed by STN-DBS as compared to dopamine replacement therapy (for a review see [4]). Moreover, while STN-DBS does not affect overall cognitive function [5,6], adverse effects of therapeutic STN-DBS have been reported for verbal fluency [7][8][9].…”

Neuropsychological outcomes from deep brain stimulation—stimulation versus micro-lesion

“…Together, these data suggest that disrupting the STN (or neighboring structures) with either stimulation or a micro-lesion leads to specific psychological deficits. This is further supported by the study of Wojtecki et al who reported that driving or activating this pathway with low frequency stimulation can improve verbal fluency (10). Now with the capability of directional steering of stimulation, further studies are needed to investigate the role of whether honing stimulation with directional steering lessens the side effects of DBS on cognition and behavior.…”

“…Earlier studies illustrated higher amplitude stimulation corresponded to decreased attention while increased pulse width improved delayed memory (9). Comparisons of different rates of STN stimulation have shown that high frequency stimulation (130 Hz or higher) worsened verbal fluency while low frequency stimulation (less than 130 Hz) appeared to improve verbal fluency (10). The authors hypothesized that low frequency stimulation activated frontal pathways while high frequency deactivates them.…”