Objective: This case report demonstrates improvement of cognition by adding low-frequency stimulation in the ventral subthalamic nucleus (STN).

Background: Deep brain stimulation (DBS) targeting the STN improves motor fluctuations in people with Parkinson’s disease, but can negatively impact cognition¹. It has been shown that 10 Hz-stimulation potentially modulates attention² although such frequency is not routinely used in light of its detrimental effect on motor control. The development of devices able to stimulate the brain with different independent frequency can overcome this issue³.

Method: A 61-year-old man with a 20-year history of Parkinson’s disease and multiple-domain mild cognitive impairment (attention, executive function and memory) underwent STN-DBS with directional leads. Marked cognitive decline was reported after initiating high frequency and increasing stimulation amplitudes, suggesting stimulation-induced cognitive decline. Programming options were limited by stimulation-induced hypomania at more ventral contact or suboptimal motor control. We opted to add a ventral contact to the configuration and stimulated this new contact at low frequency (10 Hz) and low amplitude (Table 1). Neuropsychological testing was executed before adding this ventral contact and at one month after adding the new setting to examine cognitive effects.

Results: Initial post-DBS neuropsychological testing revealed severe cognitive decline relative to pre-DBS assessment across several cognitive domains (e.g., global cognition, processing speed, memory, naming and executive functioning), as well as on a care-partner questionnaire. A subset of measures was repeated one-month following the addition of the low frequency ventral stimulation and showed improvements in processing speed, memory, naming, and executive functioning (verbal fluency), as well as on the care-partner’s ratings of executive dysfunction (Table 2). Despite these gains, performance was below pre-operative levels. The cognitive gains were reportedly retained at one-year follow-up based on the patient’s and care-partner’s report.

Conclusion: Cognitive decline after STN-DBS can be detrimental and in some cases reprogramming to more dorsal contacts can improve cognition⁴. In our patient, the cognitive side effects could be minimized by adding a ventral contact at 10-Hz stimulation. More research is needed before any further conclusions can be drawn.

References: 1. Cernera S, Okun MS, Gunduz A. A Review of Cognitive Outcomes Across Movement Disorder Patients Undergoing Deep Brain Stimulation. Front Neurol. 2019;10(May). doi:10.3389/fneur.2019.00419
2. Wojtecki L, Elben S, Timmermann L, et al. Modulation of human time processing by subthalamic deep brain stimulation. PLoS One. 2011;6(9):1-10. doi:10.1371/journal.pone.0024589
3. Vitek JL, Jain R, Chen L, et al. Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson’s disease (INTREPID): a multicentre, double-blind, randomised, sham-controlled study. Lancet Neurol. 2020;19(6):491-501. doi:10.1016/S1474-4422(20)30108-3
4. Reich MM, Hsu J, Ferguson M, et al. A brain network for deep brain stimulation induced cognitive decline in Parkinson’s disease. Brain. 2022;145(4):1410-1421. doi:10.1093/brain/awac012

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MDS Abstracts - https://www.mdsabstracts.org/abstract/addition-contact-with-10-hz-stimulation-in-the-stn-may-improve-stimulation-induced-cognitive-disturbances/