Abstract
Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 483-489 |
| Number of pages | 7 |
| Journal | Neurology and Therapy |
| Volume | 8 |
| Issue number | 2 |
| DOIs | |
| State | Published - Dec 1 2019 |
Funding
The Rush Parkinson’s Disease and Movement Disorder Program is a designated Parkinson’s Foundation Center of Excellence. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. JAK: research project: conception, organization and execution; statistical analysis: design, execution, review and critique; manuscript preparation: writing of first draft, review and critique. BO: statistical analysis: design, execution, review and critique. LVM: research project: conception; statistical analysis: review and critique; manuscript preparation: review and critique. Jessica A. Karl, Bichun Ouyang, and Leo Verhagen Metman have nothing to declare. Leo Verhagen Metman is a member of the journal’s Editorial Board. The Rush University Medical Center Institutional Review Board (IRB) approved this study (ID #19012501-IRB01). The study conforms with the 1964 Declaration of Helsinki of 1964, as revised in 2013, concerning human rights. Informed patient consent was not necessary for this work. The datasets generated and/or analyzed during the current study are not publicly available for patient confidentiality reasons, but are available from the corresponding author on reasonable request. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords
- Deep brain stimulation
- Freezing of gait
- Interleaving stimulation
- Low-frequency stimulation
- Parkinson’s disease
ASJC Scopus subject areas
- Clinical Neurology
- Neurology