Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS:a mini-review

Some studies have shown that low frequency stimulation(LFS,most commonly 60 Hz),compared to high frequency stimulation(HFS,most commonly 130 Hz),has beneficial effects,short-term or even long-term,on improving freezing of gait(FOG)and other axial symptoms,including speech and swallowing function,in Parkinson disease(PD)patients with bilateral subthalamic nucleus deep brain stimulation(STN DBS).However,other studies failed to confirm this.It seems not clear what determines the difference in response to LFS.Differences in study design,such as presence or absence of FOG,exact LFS used(60 Hz versus 80 Hz),study size,open label versus randomized double blind assessment,retrospective versus prospective evaluation,medication On or Off state,total electric energy delivered maintained or not with the change in frequency,and the location of active contacts could all potentially affect the results.This mini-review goes over the literature with the aforementioned factors in mind,focusing on the effect of LFS versus HFS on FOG and other axial symptoms in PD with bilateral STN DBS,in an effort to extract the essential data to guide our clinical management of axial symptoms and explore the potential underlying mechanisms as well.Overall,LFS of 60 Hz seems to be consistently effective in patients with FOG at the usual HFS in regards to improving FOG,speech,swallowing function and other axial symptoms,though LFS could reduce tremor control in some patients.Whether LFS simply addresses the axial symptoms in the context of HFS or has other beneficial effects requires further studies,along with the mechanism.

Voltage adjustment improves rigidity and tremor in Parkinson's disease patients receiving deep brain stimulation

Deep brain stimulation of the subthalamic nucleus is recognized as the most effective treatment for moderate and advanced Parkinson＇s disease. Programming of the stimulation parameters is important for maintaining the efficacy of deep brain stimulation. Voltage is consid- ered to be the most effective programming parameter. The present study is a retrospective analysis of six patients with Parkinson＇s disease （four men and two women, aged 37-65 years）, who underwent bilateral deep brain stimulation of the subthalamic nucleus at the First Affiliated Hospital of Sun Yat-sen University, China, and who subsequently adjusted only the stimulation voltage. We evaluated motor symptom severity using the Unified Parkinson＇s Disease Rating Scale Part III, symptom progression using the Hoehn and Yahr scale, and the levodopa equivalent daily dose, before surgery and 1 and 2 years after surgery. The 2-year follow-up results show that rigidity and tremor improved, and clinical symptoms were reduced, while pulse width was maintained at 60 ps and frequency at 130 Hz. Voltage adjust- ment alone is particularly suitable for patients who cannot tolerate multiparameter program adjustment. Levodopa equivalent daily dose was markedly reduced 1 and 2 years after surgery compared with baseline. Our results confirm that rigidity, tremor and bradykinesia can be best alleviated by voltage adjustment. The trial was registered at ClinicalTrials.gov （identifier： NCT01934881）.