Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD

Xie, Tao; Bloom, Lisa; Padmanaban, Mahesh; Bertacchi, Breanna; Kang, Wenjun; MacCracken, Ellen; Dachman, Abraham H.; Vigil, Julie; Satzer, David; Zadikoff, Cindy; Μarkopoulou, Κaterina; Warnke, Peter C.; Kang, Un Jung

doi:10.1136/jnnp-2018-318060

Cited by 60 publications

(52 citation statements)

References 39 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…LFS (most commonly 60 Hz) STN-DBS has been tried to treat PD patients with FOG and have shown its shortterm or even long-term beneficial effects on improving FOG and other axial symptoms compared with HFS [133][134][135], although some studies argued that there was no significant difference between HFS and LFS for controlling FOG [136,137]. Currently, there are lack of metaanalysis to examine efficiency of low frequency STN-DBS on FOG, thus caution should be used in interpreting the results of these clinical studies and drawing conclusions.…”

Section: Stn-dbs Low Frequency Stimulation (Lfs)mentioning

confidence: 99%

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Gao

Tan

et al. 2020

Transl Neurodegener

120

View full text Add to dashboard Cite

Background: Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), but the mechanisms and treatments of FOG remain great challenges for clinicians and researchers. The main focus of this review is to summarize the possible mechanisms underlying FOG, the risk factors for screening and predicting the onset of FOG, and the clinical trials involving various therapeutic strategies. In addition, the limitations and recommendations for future research design are also discussed. Main body: In the mechanism section, we briefly introduced the physiological process of gait control and hypotheses about the mechanism of FOG. In the risk factor section, gait disorders, PIGD phenotype, lower striatal DAT uptake were found to be independent risk factors of FOG with consistent evidence. In the treatment section, we summarized the clinical trials of pharmacological and non-pharmacological treatments. Despite the limited effectiveness of current medications for FOG, especially levodopa resistant FOG, there were some drugs that showed promise such as istradefylline and rasagiline. Non-pharmacological treatments encompass invasive brain and spinal cord stimulation, noninvasive repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS), and physiotherapeutic approaches including cues and other training strategies. Several novel therapeutic strategies seem to be effective, such as rTMS over supplementary motor area (SMA), dual-site DBS, spinal cord stimulation (SCS) and VNS. Of physiotherapy, wearable cueing devices seem to be generally effective and promising.Conclusion: FOG model hypotheses are helpful for better understanding and characterizing FOG and they provide clues for further research exploration. Several risk factors of FOG have been identified, but need combinatorial optimization for predicting FOG more precisely. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggested that some therapeutic strategies showed promise.

show abstract

Section: Stn-dbs Low Frequency Stimulation (Lfs)mentioning

confidence: 99%

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Gao

Tan

et al. 2020

Transl Neurodegener

120

View full text Add to dashboard Cite

show abstract

“…A limitation of the present study was the omission of repeat whole UPDRS-III in each condition; this would have enabled assessment of whether improvements in speech intelligibility achieved with LFS were to the detriment of benefits to other (axial) motor symptoms, especially swallowing. Recent studies have shown that low frequency (60 Hz) stimulation has a good effect on reducing aspiration frequency, perceived swallowing difficulty, freezing of gait severity, bradykinesia and overall axial and motor symptoms, although the overall effect decreases over time [47,48]. This would be challenging however in view of patient fatigue.…”

Section: Limitations Of the Study And Future Researchmentioning

confidence: 99%

Effect of Low versus High Frequency Subthalamic Deep Brain Stimulation on Speech Intelligibility and Verbal Fluency in Parkinson’s Disease: A Double-Blind Study

Grover

Georgiev

Kalliola

et al. 2019

JPD

View full text Add to dashboard Cite

Background: Subthalamic Deep Brain Stimulation (STN-DBS) is an established treatment for late stage Parkinson's disease (PD). Speech intelligibility (SI) and verbal fluency (VF) have been shown to deteriorate following chronic STN-DBS. It has been suggested that speech might respond favourably to low frequency stimulation (LFS). Objective: We examined how speech intelligibility, perceptual speech characteristics, phonemic and semantic VF and processes underlying it (clustering and switching) respond to LFS of 60 and 80Hz in comparison to high frequency stimulation (HFS) (110, 130 and 200 Hz). Methods: In this double-blind study, 15 STN-DBS PD patients (mean age 65, SD=5.8, 14 right handed, three females), were assessed at five stimulation frequencies: 60Hz, 80Hz, 110Hz, 130Hz and 200Hz. In addition to the clinical neurological assessment of speech, VF and SI were assessed. Results: Speech intelligibility and in particular articulation, respiration, phonation and prosody improved with LFS (all p<0.05). Phonemic VF switching improved with LFS (p=0.005) but this did not translate to an improved phonemic VF score. A trend for improved semantic VF was found. A negative correlation was found between perceptual characteristics of speech and duration of chronic stimulation (all p<0.05). Conclusions: These findings highlight the need for meticulous programming of frequency to maximise speech intelligibility in chronic STN-DBS. The findings further implicate stimulation frequency in changes to specific processes underlying VF, namely phonemic switching and demonstrate the potential to address such deficits through advanced adjustment of stimulation parameters.

show abstract

“…Low-frequency STN-DBS and GPi-DBS (below 100 Hz) have shown encouraging beneficial effects on axial symptoms in PD; however, higher levels of evidence with randomized and blinded studies are needed to confirm the benefits [15]. Also, the overall benefits of low-frequency STN-DBS decrease with long-term use [16].…”

Section: Introductionmentioning

confidence: 99%

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Muthukrishnan

Abbas

Shill

et al. 2019

Sensors

View full text Add to dashboard Cite

Progressive gait dysfunction is one of the primary motor symptoms in people with Parkinson's disease (PD). It is generally expressed as reduced step length and gait speed and as increased variability in step time and step length. People with PD also exhibit stooped posture which disrupts gait and impedes social interaction. The gait and posture impairments are usually resistant to the pharmacological treatment, worsen as the disease progresses, increase the likelihood of falls, and result in higher rates of hospitalization and mortality. These impairments may be caused by perceptual deficiencies (poor spatial awareness and loss of temporal rhythmicity) due to the disruptions in processing intrinsic information related to movement initiation and execution which can result in misperceptions of the actual effort required to perform a desired movement and maintain a stable posture. Consequently, people with PD often depend on external cues during execution of motor tasks. Numerous studies involving open-loop cues have shown improvements in gait and freezing of gait (FoG) in people with PD. However, the benefits of cueing may be limited, since cues are provided in a consistent/rhythmic manner irrespective of how well a person follows them. This limitation can be addressed by providing feedback in real-time to the user about performance (closed-loop cueing) which may help to improve movement patterns. Some studies that used closed-loop cueing observed improvements in gait and posture in PD, but the treadmill-based setup in a laboratory would not be accessible outside of a research setting, and the skills learned may not readily and completely transfer to overground locomotion in the community. Technologies suitable for cueing outside of laboratory environments could facilitate movement practice during daily activities at home or in the community and could strongly reinforce movement patterns and improve clinical outcomes. This narrative review presents an overview of cueing paradigms that have been utilized to improve gait and posture in people with PD and recommends development of closed-loop wearable systems that can be used at home or in the community to improve gait and posture in PD.

show abstract

Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD

Abstract: NCT02549859; Pre-results.

Cited by 60 publications

References 39 publications

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

Effect of Low versus High Frequency Subthalamic Deep Brain Stimulation on Speech Intelligibility and Verbal Fluency in Parkinson’s Disease: A Double-Blind Study

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Contact Info

Product

Resources

About