Subthalamic deep brain stimulation at individualized frequencies for Parkinson disease

Abstract

Objectives: The oscillation model of Parkinson disease (PD) states that, in the subthalamic nucleus (STN), increased (4-10 Hz) and ␤ (11-30 Hz) frequencies were associated with worsening whereas ␥ frequencies (31-100 Hz) were associated with improvement of motor symptoms. However, the peak STN frequency in each band varied widely from subject to subject. We hypothesized that STN deep brain stimulation (DBS) at individualized ␥ frequencies would improve whereas or ␤ frequencies would worsen PD motor signs. Methods:We prospectively studied 13 patients with PD. STN local field potential (LFP) was recorded after electrode implantations, in the OFF and then in ON dopaminergic medication states while patients performed wrist movements. Six individual peak frequencies of the STN LFP power spectra were obtained: the greatest decrease in and ␤ and greatest increase in ␥ frequencies in the ON state (MED) and during movements (MOVE). Eight DBS frequencies were applied including 6 MED and MOVE frequencies, high frequency (HF) used for chronic stimulation, and no stimulation. The patients were assessed using the motor Unified Parkinson's Disease Rating Scale (mUPDRS).Results: STN DBS at ␥ frequencies (MED and MOVE) and HF significantly improved mUPDRS scores compared to no stimulation and both ␥ frequencies were not different from HF. DBS at and ␤ frequencies did not worsen mUPDRS scores compared to no stimulation. Conclusion:Short-term administration of STN DBS at peak dopamine-dependent or movementrelated ␥ frequencies were as effective as HF for reducing parkinsonian motor signs but DBS at and ␤ frequencies did not worsen PD motor signs. Classification of evidence:This study provides Class III evidence that STN DBS at patient-specific ␥ frequencies and at usual high frequencies both improved mUPDRS scores compared to no stimulation and did not differ in effect. Neurology 1 Studies of oscillatory activities in the basal ganglia (BG) in patients with PD suggested that parkinsonian motor symptoms may be related to excessive pathologic oscillations in the BG in the low frequencies (Ͻ30 Hz).2,3 Increased (4 -10 Hz) frequencies in STN were associated with parkinsonian resting tremor. 4 Moreover, excessive ␤ (11-30 Hz) frequencies were recorded from the STN when patients with PD were withdrawn from their dopaminergic medications (OFF state) 5-7 and these frequencies were reduced when patients were in the on dopaminergic

Reduced dynamics for delayed systems with harmonic or stochastic forcing

“…To the best of our knowledge, our study is the first to treat analytically the dynamics of delayed system controlled by external driving. Notably, such control is widely applied in various neuroscience fields, such as in neuropsychological experiments in form of flicker experiments [63] or as Deep Brain Stimulation in Parkinson Disease [62,64], to name a few. The present work fills this gap and illustrates the practical mathematical application by a rather simple but revealing non-linear example.…”

Deep brain stimulation for movement disorders

“…(c) The eight-contact lead produced by Boston Scientific can allow the stimulation of multiple sites along the same trajectory, as shown in a patient with Parkinson's disease who underwent concomitant stimulation of STN (to improve parkinsonism), STA (to improve stimulation-induced dyskinesias) and thalamus (to improve tremor) [120]. Deep brain stimulation for movement disorders Fasano and Lozano with Parkinson's disease recently implanted in the STN has shown that stimulation at the same frequency of the individual local field potentials associated with voluntary movement (gamma band) was comparable to standard stimulation [128]. The same concepts (i.e.…”

Deep brain stimulation for obesity: past, present, and future targets

“…1,11,19,29,48,87,102 As currently used, DBS is effective when administered at what is considered high-frequency stimulation (HFS; that is, at > 100 Hz); however, there is evidence that the parameters of stimulation used in treating movement disorders may not be optimal for treating diseases such as obesity. 96,104 In addition, targeting several brain structures with DBS to treat neuropsychiatric disorders has been shown to engender weight loss and reduce addiction, 45,57 lending further evidence to the notion that multinodal circuits rather than a localized area of the brain are involved in many of these disorders. In this review, we discuss the targets and outcomes of DBS for managing obesity and the progression of the field.…”