RT Journal Article
SR Electronic
T1 Subthalamic deep brain stimulation at individualized frequencies for Parkinson disease
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1930
OP 1938
DO 10.1212/WNL.0b013e318259e183
VO 78
IS 24
A1 Tsang, E.W.
A1 Hamani, C.
A1 Moro, E.
A1 Mazzella, F.
A1 Saha, U.
A1 Lozano, A.M.
A1 Hodaie, M.
A1 Chuang, R.
A1 Steeves, T.
A1 Lim, S.Y.
A1 Neagu, B.
A1 Chen, R.
YR 2012
UL http://n.neurology.org/content/78/24/1930.abstract
AB Objectives: The oscillation model of Parkinson disease (PD) states that, in the subthalamic nucleus (STN), increased θ (4–10 Hz) and β (11–30 Hz) frequencies were associated with worsening whereas γ 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 γ frequencies would improve whereas θ or β 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 θ and β and greatest increase in γ 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 γ frequencies (MED and MOVE) and HF significantly improved mUPDRS scores compared to no stimulation and both γ frequencies were not different from HF. DBS at θ and β frequencies did not worsen mUPDRS scores compared to no stimulation. Conclusion: Short-term administration of STN DBS at peak dopamine-dependent or movement-related γ frequencies were as effective as HF for reducing parkinsonian motor signs but DBS at θ and β frequencies did not worsen PD motor signs. Classification of evidence: This study provides Class III evidence that STN DBS at patient-specific γ frequencies and at usual high frequencies both improved mUPDRS scores compared to no stimulation and did not differ in effect. BG=basal ganglia; DBS=deep brain stimulation; HF=high frequency; LFP=local field potential; MED=medication-dependent peak frequencies; MOVE=movement-related peak frequencies; mUPDRS=motor Unified Parkinson's Disease Rating Scale; PD=Parkinson disease; rmANOVA=repeated-measures analysis of variance; STN=subthalamic nucleus; TEED=total electrical energy delivered; VT=ventral thalamus