Low-frequency Versus High-frequency Subthalamic Nucleus Deep Brain Stimulation on Postural Control and Gait in Parkinson's Disease: A Quantitative Study

Vallabhajosula, Srikant; Haq, Ihtsham; Hwynn, Nelson; Oyama, Genko; Okun, Michael S.; Tillman, Mark D.; Hass, Chris J.

doi:10.1016/j.brs.2014.10.011

Cited by 86 publications

(89 citation statements)

References 38 publications

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“…All articles in which the two authors agreed on eligibility were included. There were five articles, all in persons with Parkinson disease, that used brain stimulation as an experimental maneuver to assess effects on gait variability (Hausdorff et al 2009, Fasano et al 2010, Thevathasan et al 2012, Kaski et al 2013, Vallabhajosula et al 2015). After discussion, these studies were felt to deserve a separate evaluation and discussion due to the unique pathology and gait characteristics of the disease.…”

Section: Methodsmentioning

confidence: 99%

The brain map of gait variability in aging, cognitive impairment and dementia—A systematic review

Tian

Chastan

Bair

et al. 2017

Neuroscience & Biobehavioral Reviews

126

112

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While gait variability may reflect subtle changes due to aging or cognitive impairment (CI), associated brain characteristics remain unclear. We summarize structural and functional neuroimaging findings associated with gait variability in older adults with and without CI and dementia. We identified 17 eligible studies; all were cross-sectional; few examined multiple brain areas. In older adults, temporal gait variability was associated with structural differences in medial areas important for lower limb coordination and balance. Both temporal and spatial gait variability were associated with structural and functional differences in hippocampus and primary sensorimotor cortex and structural differences in anterior cingulate cortex, basal ganglia, association tracts, and posterior thalamic radiation. In CI or dementia, some associations were found in primary motor cortex, hippocampus, prefrontal cortex and basal ganglia. In older adults, gait variability may be associated with areas important for sensorimotor integration and coordination. To comprehend the neural basis of gait variability with aging and CI, longitudinal studies of multiple brain areas are needed.

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Section: Methodsmentioning

confidence: 99%

The brain map of gait variability in aging, cognitive impairment and dementia—A systematic review

Tian

Chastan

Bair

et al. 2017

Neuroscience & Biobehavioral Reviews

126

112

View full text Add to dashboard Cite

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“…In particular, short pulse widths decrease the activation of surrounding fibers as a result of specific axon properties such as chronaxie. Recently, an increasing number of reports have explored the use of low-frequency stimulation (60-80 Hz) to improve axial symptoms including freezing of gait, postural control, dysarthria, swallowing function and also bradykinesia [50,[52][53][54][55]. However, these reports only addressed the short-term effects, and the initial promising results were limited either by the transient clinical benefits or worsening of appendicular symptoms [52,56].…”

Section: Stn Imaging and Target Selectionmentioning

confidence: 96%

Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson’s disease

Bari

Fasano

Munhoz

et al. 2015

Expert Review of Neurotherapeutics

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The subthalamic nucleus (STN) has been a major target of deep brain stimulation (DBS) for Parkinson's disease (PD) over the past 20 years. The benefits of DBS of the STN include: decreased motor fluctuations and bradykinesia, tremor reduction and a reduction in dopaminergic drug requirements and dyskinesias. Despite these overall positive effects, the outcomes of STN DBS can be variable, contributing to the debate over the best DBS target for PD. Here, the authors review the current practice of STN DBS and also review both the existing and emerging technologies that are likely to improve the accuracy and effectiveness of STN DBS for PD. The authors emphasize patient selection, accuracy of electrode placement within the brain and the selection of appropriate stimulation parameters to optimize clinical benefits.

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“…Vallabhajosula et al studied 19 PD patients with bilateral STN DBS without pre-defined FOG state [15]. UPDRS III scores, static and dynamic postural control using gait initiation and gait evaluations were assessed in three conditions at medication Off state: DBS Off, LFS (60 Hz), and HFS (>100 Hz).…”

Section: Lfs (60 Hz or Below) Versus Hfs (≥130 Hz Or >100 Hz) In Patimentioning

confidence: 99%

“…Some studies had TEED maintained [4, 5, 8, 9, 16], but others did not [6, 7, 12–15]. Phibbs et al studied 20 PD patients who were at least 3 months after on bilateral STN DBS with changes in gait (7 with balance issues, 7 with FOG, 6 with festination) [12].…”

Section: Effect Of Teed On the Effect Of Lfs Versus Hfsmentioning

confidence: 99%

“…Low frequency stimulation (LFS, most commonly 60 Hz), compared to HFS (most commonly 130 Hz), has been shown to have beneficial effects on improving FOG and other axial symptoms, such as speech and swallowing function, in PD patients with bilateral STN DBS in some studies [4–10], or selected patients [11], but not in others [12–15]. Some found short-term but not long-term beneficial effect [16], while others found both short-term and long-term benefits after 6 weeks, 8 months and even 10 months study periods [4, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review

Xie

Padmanaban

Bloom

et al. 2017

Transl Neurodegener

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Some studies have shown that low frequency stimulation (LFS, most commonly 60 Hz), compared to high frequency stimulation (HFS, most commonly 130 Hz), has beneficial effects, short-term or even long-term, on improving freezing of gait (FOG) and other axial symptoms, including speech and swallowing function, in Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN DBS). However, other studies failed to confirm this. It seems not clear what determines the difference in response to LFS. Differences in study design, such as presence or absence of FOG, exact LFS used (60 Hz versus 80 Hz), study size, open label versus randomized double blind assessment, retrospective versus prospective evaluation, medication On or Off state, total electric energy delivered maintained or not with the change in frequency, and the location of active contacts could all potentially affect the results. This mini-review goes over the literature with the aforementioned factors in mind, focusing on the effect of LFS versus HFS on FOG and other axial symptoms in PD with bilateral STN DBS, in an effort to extract the essential data to guide our clinical management of axial symptoms and explore the potential underlying mechanisms as well. Overall, LFS of 60 Hz seems to be consistently effective in patients with FOG at the usual HFS in regards to improving FOG, speech, swallowing function and other axial symptoms, though LFS could reduce tremor control in some patients. Whether LFS simply addresses the axial symptoms in the context of HFS or has other beneficial effects requires further studies, along with the mechanism.

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Low-frequency Versus High-frequency Subthalamic Nucleus Deep Brain Stimulation on Postural Control and Gait in Parkinson's Disease: A Quantitative Study

Cited by 86 publications

References 38 publications

The brain map of gait variability in aging, cognitive impairment and dementia—A systematic review

The brain map of gait variability in aging, cognitive impairment and dementia—A systematic review

Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson’s disease

Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS: a mini-review

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