Objective: This study aims to investigate whether low-frequency stimulation (LFS) (<100Hz, mostly 60 or 80 Hz) affects motor symptoms of Parkinson’s disease differently from high-frequency stimulation (HFS) (>100Hz, mostly 130 or 150 Hz) in deep brain stimulation (DBS) targeting subthalamic nucleus (STN).

Background: The effects of DBS largely depend on programming the parameters, including intensity, frequency, pulse width, and contacts configuration. Up to date, this procedure mostly relies on the experience of physicians and no guideline is available. Although the roles of stimulation intensity (amplitude or current) and pulse width have been understood as related to the activation of axonal elements, the effects and mechanism concerning frequency of on motor symptoms have not been studied in detail.

Methods: A meta-analysis in a random-effect model was conducted after comprehensive review and data extraction of current literature using online databases. Nine studies including 132 patients were analyzed.

Results: The pooled results showed that the effects of HFS and LFS on total Unified Parkinson Disease Rating Scale part III (UPDRS-III) scores (mean effect, 0.72, p>0.05) and rigidity subscores (mean effect, 0.54, p>0.05) were similar. However, compared to LFS, HFS reduced tremor subscores to a larger degree (mean effect, 0.93, p=0.0005). On the other hand, LFS had superior efficacy over HFS not only on reducing akinesia subscores in UPDRS-III (mean effect, -1.42, p=0.005), but also on shortening complete time in stand-walk-sit (SWS) test (mean effect, -8.78, p<0.05) (Figure 1).

Conclusions: Our findings suggest that tremor responds better to HFS, while akinesia and gait velocity have a greater response to LFS. This study provides us with better resolutions for different motor symptoms during STN-DBS programming.

References: Khoo HM, Kishima H, Hosomi K, Maruo T, Tani N, Oshino S, et al. Low-frequency subthalamic nucleus stimulation in Parkinson’s disease: a randomized clinical trial. Mov Disord. 2014;29(2):270-4. doi: 10.1002/mds.25810. PubMed PMID: 24449169. Tao Xie M, PhD Julie Vigil, MA, Ellen MacCracken MAG, MD Joan Young, BS Wenjun Kang, MS Jacqueline Bernard, MD Peter Warnke, MD, Un J. Kang M. Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD. Neurology. 2015.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frequency-dependent-effects-of-subthalamic-deep-brain-stimulation-on-motor-symptoms-in-parkinsons-disease/