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Mov Disord. 2016 Jul;31(7):962-7. doi: 10.1002/mds.26658. Epub 2016 May 13.

Low-frequency deep brain stimulation for Parkinson's disease: Great expectation or false hope?

Author information

  • 1Neurology Unit, Campus Bio-Medico University of Rome, Rome, Italy.
  • 2Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • 3Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Oxford, UK.
  • 4Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

Abstract

The long-term efficacy of subthalamic deep brain stimulation for Parkinson's disease is not always retained, and many patients lose the improvement achieved during the "second honeymoon" following surgery. Deep brain stimulation is a versatile tool, as stimulation parameters may undergo a fine-tuning depending on clinical needs. Among them, frequency is the parameter that leads to more complex scenarios because there is no generalizable relationship between its modulation and the overall clinical response, which also depends on the specific considered sign. High-frequency stimulation (>100 Hz) has shown to be effective in improving most parkinsonian signs, particularly the levodopa-responsive ones. However, its effect on axial signs (such as balance, gait, speech, or swallowing) may not be sustained, minimal, or even detrimental. For these reasons, several studies have explored the effectiveness of low-frequency stimulation (generally 60 or 80 Hz). Methods, results, and especially interpretations of these studies are quite variable. Although the use of low-frequency stimulation certainly opens new avenues in the field of deep brain stimulation, after having gathered all the available evidence in patients with subthalamic implants, our conclusion is that it might be clinically useful mainly when it lessens the detrimental effects of high-frequency stimulation. © 2016 International Parkinson and Movement Disorder Society.

KEYWORDS:

Parkinson's disease; deep brain stimulation; low-frequency stimulation

PMID:
27173938
DOI:
10.1002/mds.26658
[PubMed - in process]

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