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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) using high-frequency (130–185 Hz) stimulation (HFS) is more effective for appendicular than for axial symptoms. Low-frequency stimulation (LFS) of the STN may reduce gait/balance and speech impairment but can result in worsened appendicular symptoms, limiting its clinical usefulness. A novel dual-frequency paradigm (interleave–interlink, IL–IL) was created in order to reduce gait/balance and speech impairment while maintaining appendicular symptom control in Parkinson’s disease (PD) patients chronically stimulated with DBS.
Two overlapping LFS programs are applied to each DBS lead, with the overlapping area focused around the optimal electrode contact. As a result, this area receives HFS, controlling appendicular symptoms. The non-overlapping area receives LFS, potentially reducing gait/balance and speech impairment. Patients were separated into three categories based on their chief complaint(s): gait/balance impairment, speech impairment, and/or incomplete PD symptom control. The Clinical- Global Impression of Change scale (CGI-C) was completed retrospectively based on patient/caregiver feedback in patients who remained on IL–IL (at 3 months and at the last follow-up).
Seventy-six patients were switched from optimized HFS to IL–IL. Fifty-five (72%) patients remained on IL–IL after 22 ± 8.7 months. The median (range) CGI-C for gait was 2 (1–5) at 3 months and 3 (1–4) at last follow-up, for dysarthria it was 4 (1–4) at 3 months and 4 (1–5) at last follow-up, and for PD motor it was 2 (1–3) at 3 months and 2 (1–3) at last follow-up.
A substantial number of patients remained on IL–IL because of subjective improvements in gait/balance, speech, or PD symptoms. A prospective, double-blind, crossover study with objective/quantitative outcome measures is underway.
Busner J, Targum SD. The Clinical Global Impressions Scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):28–37.
Valldeoriola F, Munoz E, Rumia J, et al. Simultaneous low-frequency deep brain stimulation of the substantia nigra pars reticulata and high-frequency stimulation of the subthalamic nucleus to treat levodopa unresponsive freezing of gait in Parkinson’s disease: a pilot study. Parkinsonism Relat Disord. 2019;60:153–7. CrossRef
- A Novel Dual-Frequency Deep Brain Stimulation Paradigm for Parkinson’s Disease
Jessica A. Karl
Leo Verhagen Metman
- Springer Healthcare
Neurology and Therapy
Print ISSN: 2193-8253
Elektronische ISSN: 2193-6536
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