Objective: To document DBS induced frequency parameter neuroplasticity in STN DBS implanted individuals with tremor dominant PD.

Background: We have noted the ability to reduce the DBS frequency parameter in STN implanted, tremor dominant PD individuals to levels which earlier would have released tremor symptoms. We undertake a chart review to examine the supporting evidence.

Method: Charts of 85 sequential cases implanted at our institution from January 2013 to August 2016. From these records we drew 20 tremor dominant PD STN cases, 8 nontremor dominant PD STN cases, and 9 Essential tremor (ET) VIM DBS cases. The value of the DBS frequency parameter at the end of the initial contact screen was compared to the frequency at the initial device exchange.

Results: Tremor dominant PD individuals had a mean UPDRS III “Off” tremor subscore at the contact screen of 5.61 (sem=1.05) and a total UPDRS III “Off” score of 33.58 (sem=2.11). The final frequency parameter for the Tremor group at the end of the contact screen was an average of 182.22Hz (sem=5.56 range 150Hz-200Hz). By the programming session following battery exchanges, an average of 3.64 years later, the frequency was reduced to 131.39Hz (sem=7.59 range 75Hz-170Hz). At this time the Tremor group had a mean UPDRS III “On” tremor subscore of 0.39 (sem=0.153) and a total UPDRS III “On” score of 11.61 (sem=1.84). The Nontremor group also exhibited a reduction in frequency from contact screen to device exchange 4.35 years (119.37Hz sem=4.99 – 76.25Hz sem=4.92). The accompanying UPDRS III “Off” tremor subscore was 0.50 (sem=0.40) and total score was 27.6 (sem=6.29), at the device exchange the “On” tremor subscore was 0.37 (sem=0.28) and the total “On” score was 17.64 (sem=7.33). In contrast, the ET group exhibited no difference in frequency from contact screen to device exchange 4.16 years (177.27Hz sem=2.04 – 185.91Hz sem=7.96).

Conclusion: Both the Tremor and Nontremor PD groups exhibited similar reductions in frequency over time, which did not extend to the ET group. Identifying the necessary frequency for the Tremor and ET groups is straight forward, but not for the Nontremor group. Thus, the frequency parameter and its control over tremor in the Tremor group exhibits plasticity, but the same is not definitive for the Nontremor PD and ET groups.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/plasticity-of-frequency-dependent-tremor-control-in-parkinson-disease-pd-subthalamic-nucleus-stn-deep-brain-stimulation-dbs-implanted-individuals/