Dataset Information

Deep Brain Stimulation at Variable Frequency to Improve Motor Outcomes in Parkinson's Disease.

ABSTRACT:

Introduction

Deep brain stimulation (DBS) with high frequency (HFS) is a well-established therapy for Parkinson's disease (PD); however, low frequency DBS (LFS) may control axial symptoms including freezing of gait (FOG). We conducted a pilot safety and feasibility study to examine if a novel DBS paradigm of variable frequency stimulation (VFS) that combined HFS and LFS would capture a broader set of motor symptoms.

Methods

Four PD patients with bilateral STN DBS and FOG were enrolled. A UPDRS III and 10 m timed up and go (TUG) task were performed off medications-off DBS and then one hour after HFS and one hour after VFS programming.

Results

The UPDRS III motor score improved by additional 14% during VFS setting when compared to HFS. VFS also increased gait speed (mean change 45%) and reduced the number of freezing episodes (mean change 58%).

Conclusions

SUBMITTER: Jia F

PROVIDER: S-EPMC6207106 | biostudies-literature | 2018 Sep-Oct

REPOSITORIES: biostudies-literature

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Publications

Deep Brain Stimulation at Variable Frequency to Improve Motor Outcomes in Parkinson's Disease.

Jia Fumin F Wagle Shukla Aparna A Hu Wei W Almeida Leonardo L Holanda Vanessa V Zhang Jianguo J Meng Fangang F Okun Michael S MS Li Luming L

Movement disorders clinical practice 20180901 5

<h4>Introduction</h4>Deep brain stimulation (DBS) with high frequency (HFS) is a well-established therapy for Parkinson's disease (PD); however, low frequency DBS (LFS) may control axial symptoms including freezing of gait (FOG). We conducted a pilot safety and feasibility study to examine if a novel DBS paradigm of variable frequency stimulation (VFS) that combined HFS and LFS would capture a broader set of motor symptoms.<h4>Methods</h4>Four PD patients with bilateral STN DBS and FOG were enro ...[more]

PMID: 30637270

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Project description:ObjectiveA motor speech disorder or dysarthria commonly arises in patients with Parkinson's disease (PD). The impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on motor speech and the potential of intraoperative motor speech testing to predict outcomes are unknown. This study examined 1) the types and prevalence of motor speech changes observed with STN DBS and their relation to the preoperative condition, 2) the ability of intraoperative testing to predict postoperative changes in motor speech, and 3) the spatial relationship between stimulation sites producing maximal motor improvement, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and maximal motor speech deterioration.MethodsComprehensive preoperative, intraoperative, and postoperative motor speech/dysarthria evaluations were performed in consecutive patients with advanced idiopathic PD who underwent STN DBS surgery in the period from 2011 to 2016. Preoperative type of dysarthria and overall dysarthria severity rating along with intraoperative motor speech testing results were evaluated as predictors of postoperative change. Atlas-independent, fully individualized field modeling was used to identify stimulation sites associated with maximal MDS-UPDRS motor improvement and motor speech deterioration.ResultsForty-three patients with PD treated with STN DBS were prospectively studied. Improved MDS-UPDRS motor scores and worsened dysarthria were demonstrated by a subset of patients (16/43). Preoperative dysarthria characteristics did not predict postoperative deterioration. Intraoperative assessment of motor speech strongly predicted postoperative outcomes (OR 4.4, p = 0.02). Sites of maximal MDS-UPDRS motor improvement and worsened dysarthria were distinct. Worsened dysarthria was associated with capsular stimulation, anterior and ventral to the site of maximal MDS-UPDRS motor improvement.ConclusionsThe predictive reliability of intraoperative motor speech testing, together with the identification of distinct stimulation sites for motor speech impairment and improved MDS-UPDRS motor function, raise the possibility that DBS lead repositioning or reprogramming could reduce adverse effects on motor speech without impacting MDS-UPDRS motor outcomes in patients undergoing STN DBS.

Project description:The disruption of pathologically enhanced beta oscillations is considered one of the key mechanisms mediating the clinical effects of deep brain stimulation on motor symptoms in Parkinson's disease. However, a specific modulation of other distinct physiological or pathological oscillatory activities could also play an important role in symptom control and motor function recovery during deep brain stimulation. Finely tuned gamma oscillations have been suggested to be prokinetic in nature, facilitating the preferential processing of physiological neural activity. In this study, we postulate that clinically effective high-frequency stimulation of the subthalamic nucleus imposes cross-frequency interactions with gamma oscillations in a cortico-subcortical network of interconnected regions and normalizes the balance between beta and gamma oscillations. To this end we acquired resting state high-density (256 channels) EEG from 31 patients with Parkinson's disease who underwent deep brain stimulation to compare spectral power and power-to-power cross-frequency coupling using a beamformer algorithm for coherent sources. To show that modulations exclusively relate to stimulation frequencies that alleviate motor symptoms, two clinically ineffective frequencies were tested as control conditions. We observed a robust reduction of beta and increase of gamma power, attested in the regions of a cortical (motor cortex, supplementary motor area, premotor cortex) and subcortical network (subthalamic nucleus and cerebellum). Additionally, we found a clear cross-frequency coupling of narrowband gamma frequencies to the stimulation frequency in all of these nodes, which negatively correlated with motor impairment. No such dynamics were revealed within the control posterior parietal cortex region. Furthermore, deep brain stimulation at clinically ineffective frequencies did not alter the source power spectra or cross-frequency coupling in any region. These findings demonstrate that clinically effective deep brain stimulation of the subthalamic nucleus differentially modifies different oscillatory activities in a widespread network of cortical and subcortical regions. Particularly the cross-frequency interactions between finely tuned gamma oscillations and the stimulation frequency may suggest an entrainment mechanism that could promote dynamic neural processing underlying motor symptom alleviation.

Project description:ObjectiveThe aim of this study was to evaluate the neurobehavioral safety of constant-current subthalamic deep brain stimulation and to compare the neuropsychological effects of stimulation versus electrode placement alone.MethodsA total of 136 patients with Parkinson's disease underwent bilateral subthalamic device implantation in this randomized trial. Patients received stimulation either immediately after device implantation (n = 101; active stimulation) or beginning 3 months after surgery (n = 35; delayed activation control). Patients were administered neuropsychological tests before, 3, and 12 months after device implantation.ResultsNeuropsychological change in stimulation and control groups were comparable. Within-group analyses revealed declines in category and switching verbal fluency in both groups, but only the stimulation group had letter verbal fluency and Stroop task declines. Depression symptom improvements occurred in both groups, but more often in the stimulation group. Letter fluency declines were associated with worse Parkinson's Disease Questionnaire Communication subscale scores. Baseline and 12-month comparisons (in the combined group) revealed gains in verbal and visual delayed recall scores and improvement in depression symptoms, but decrements in verbal fluency and Stroop scores.ConclusionsConstant-current bilateral subthalamic stimulation had a good cognitive safety profile except for decrements in verbal fluency and on the Stroop task. These abnormalities are related to device implantation, but stimulation likely had an additive effect. One year after surgery, the cognitive changes did not exert a detrimental effect on quality of life, although letter fluency declines were associated with communication dissatisfaction at 12 months. Improvement in depressive symptom severity appears dependent on stimulation and not placebo or lesion effects. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Dataset Information

Deep Brain Stimulation at Variable Frequency to Improve Motor Outcomes in Parkinson's Disease.

Introduction

Methods

Results

Conclusions

Publications

Deep Brain Stimulation at Variable Frequency to Improve Motor Outcomes in Parkinson's Disease.

Similar Datasets

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