Impact of Subthalamic Deep Brain Stimulation Frequency on Upper Limb Motor Function in Parkinson’s Disease

Abstract

Background:Whilst changes in the frequency of subthalamic deep brain stimulation (STN-DBS) have been proposed to improve control of tremor or axial motor features in Parkinson’s disease (PD), little is known about the effects of frequency changes on upper limb motor function, particularly bradykinesia.Objective:To investigate the acute effects of various STN-DBS frequencies (40–160 Hz, 40 Hz intervals) on upper limb motor function.Methods:We carried out a randomised, double-blind study on 20 PD patients with chronic STN-DBS using the Simple and Assembly components of the Purdue Pegboard (PP) test and a modified upper limb version of the UPDRS-III (UL-UPDRS-III).Results:There was no significant effect of frequency on bradykinesia on the Simple PP task or the UL-UPDRS-III. There was an effect of frequency on the Assembly PP score when comparing all frequencies (p = 0.019) and between 80 Hz and 130 Hz (p = 0.007), with lower frequencies yielding a better performance. Rigidity and Tremor scores were significantly reduced with higher (>80 Hz) compared to lower (40 Hz) frequencies.Conclusions:Our findings suggest that a wide range of frequencies are efficacious in improving acute upper-limb motor function. Reducing the frequency of stimulation down to 80 Hz is safe and has a similar clinical effect to higher frequencies. Therefore, a wider range of frequencies are available when it comes adjusting patients’ acute settings without the risk of worsening bradykinesia.

Therapeutic Window of Deep Brain Stimulation Using Cathodic Monopolar, Bipolar, Semi-Bipolar, and Anodic Stimulation

“…Patients were blinded to each stimulation condition and the order of assessment was not randomized. In keeping with similar previous studies (9,(12)(13)(14)(15), each upper limb was tested separately for the therapeutic threshold, defined as the amplitude where reduction of rigidity (MDS-UPDRS Part III, Factor 3 16 = 0) or hypotonia was induced by stimulation. Side-effect threshold was determined as the amplitude causing one or more permanent side-effects.…”

Persistent synaptic inhibition of the subthalamic nucleus by high frequency stimulation

“…This corresponds to clinical observations that have found that stimulation frequencies above 100 Hz or even the conventional 130 Hz can provide additional benefit in refractory or tremor dominant cases treated with STN-DBS. [32][33][34]…”

Noise-Induced Synchronization and Antiresonance in Interacting Excitable Systems: Applications to Deep Brain Stimulation in Parkinson’s Disease

“…Some 30 years ago, it was observed that high-frequency stimulation (∼130 Hz) in the basal ganglia relay nucleus, the subthalamic nucleus, had a remarkable effect of alleviating Parkinson's disease symptoms [50,54,57,78,80]. Clinically, the impact of DBS strongly depends on stimulation amplitude and frequency [81]: too-high stimulation frequencies (>180 Hz) were reported to be therapeutically ineffective [50,82], while too low stimulation frequencies have a still debated impact. Indeed, some studies showed that low-frequency stimulation could worsen some parkinsonian symptoms such as tremors and rigidity [83], possibly by imposing another oscillatory rhythm onto the basal ganglia network, while others showed a beneficial impact of lowfrequency stimulation for gait control and cognitive functions [84].…”