The oscillation model of Parkinson disease (PD) states that, in the subthalamic nucleus (STN), increased (4–10 Hz) and β (11–30 Hz) frequencies were associated with worsening whereas frequencies (31–100 Hz) were associated with improvement of motor symptoms. However, the peak STN frequency in each band varied widely from subject to subject. We hypothesized that STN deep brain stimulation (DBS) at individualized frequencies would improve whereas or β frequencies would worsen PD motor signs.
Methods:We prospectively studied 13 patients with PD. STN local field potential (LFP) was recorded after electrode implantations, in the OFF and then in ON dopaminergic medication states while patients performed wrist movements. Six individual peak frequencies of the STN LFP power spectra were obtained: the greatest decrease in and β and greatest increase in frequencies in the ON state (MED) and during movements (MOVE). Eight DBS frequencies were applied including 6 MED and MOVE frequencies, high frequency (HF) used for chronic stimulation, and no stimulation. The patients were assessed using the motor Unified Parkinson's Disease Rating Scale (mUPDRS).
Results:STN DBS at frequencies (MED and MOVE) and HF significantly improved mUPDRS scores compared to no stimulation and both frequencies were not different from HF. DBS at and β frequencies did not worsen mUPDRS scores compared to no stimulation.
Conclusion:Short-term administration of STN DBS at peak dopamine-dependent or movement-related frequencies were as effective as HF for reducing parkinsonian motor signs but DBS at and β frequencies did not worsen PD motor signs.
Classification of evidence:This study provides Class III evidence that STN DBS at patient-specific frequencies and at usual high frequencies both improved mUPDRS scores compared to no stimulation and did not differ in effect.
No comments:
Post a Comment