Low-frequency STN-DBS Provides Acute Gait Improvements in Parkinson's Disease: a Double-blinded Randomised Cross-over Feasibility Trial

Overview

Journal J Neuroeng Rehabil

Publisher Biomed Central

Specialties Biomedical Engineering
Neurology
Rehabilitation Medicine

Date 2021 Aug 11

PMID 34376190

Citations 13

Authors

Zachary J Conway

Peter A Silburn

Thushara Perera

Karen OMaley

Michael H Cole

Affiliations

Soon will be listed here.

Abstract

Background: Some people with Parkinson's disease (PD) report poorer dynamic postural stability following high-frequency deep brain stimulation of the subthalamic nucleus (STN-DBS), which may contribute to an increased falls risk. However, some studies have shown low-frequency (60 Hz) STN-DBS improves clinical measures of postural stability, potentially providing support for this treatment. This double-blind randomised crossover study aimed to investigate the effects of low-frequency STN-DBS compared to high-frequency stimulation on objective measures of gait rhythmicity in people with PD.

Methods: During high- and low-frequency STN-DBS and while off-medication, participants completed assessments of symptom severity and walking (e.g., Timed Up-and-Go). During comfortable walking, the harmonic ratio, an objective measures of gait rhythmicity, was derived from head- and trunk-mounted accelerometers to provide insight in dynamic postural stability. Lower harmonic ratios represent less rhythmic walking and have discriminated people with PD who experience falls. Linear mixed model analyses were performed on fourteen participants.

Results: Low-frequency STN-DBS significantly improved medial-lateral and vertical trunk rhythmicity compared to high-frequency. Improvements were independent of electrode location and total electrical energy delivered. No differences were noted between stimulation conditions for temporal gait measures, clinical mobility measures, motor symptom severity or the presence of gait retropulsion.

Conclusions: This study provides evidence for the acute benefits of low-frequency stimulation for gait outcomes in STN-DBS PD patients, independent of electrode location. However, the perceived benefits of this therapy may be diminished for people who experienced significant tremor pre-operatively, as lower frequencies may cause these symptoms to re-emerge.

Trial Registration: This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry on 5 June 2018 (ACTRN12618000944235).

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References

Hubble R, Naughton G, Silburn P, Cole M . Wearable sensor use for assessing standing balance and walking stability in people with Parkinson's disease: a systematic review. PLoS One. 2015; 10(4):e0123705. PMC: 4403989. DOI: 10.1371/journal.pone.0123705. View

Cole M, Silburn P, Wood J, Kerr G . Falls in Parkinson's disease: evidence for altered stepping strategies on compliant surfaces. Parkinsonism Relat Disord. 2011; 17(8):610-6. DOI: 10.1016/j.parkreldis.2011.05.019. View

Cole M, Sweeney M, Conway Z, Blackmore T, Silburn P . Imposed Faster and Slower Walking Speeds Influence Gait Stability Differently in Parkinson Fallers. Arch Phys Med Rehabil. 2016; 98(4):639-648. DOI: 10.1016/j.apmr.2016.11.008. View

Cole M, Silburn P, Wood J, Worringham C, Kerr G . Falls in Parkinson's disease: kinematic evidence for impaired head and trunk control. Mov Disord. 2010; 25(14):2369-78. DOI: 10.1002/mds.23292. View

Johnsen E, Sunde N, Mogensen P, Ostergaard K . MRI verified STN stimulation site--gait improvement and clinical outcome. Eur J Neurol. 2010; 17(5):746-53. DOI: 10.1111/j.1468-1331.2010.02962.x. View

Koss A, Alterman R, Tagliati M, Shils J . Calculating total electrical energy delivered by deep brain stimulation systems. Ann Neurol. 2005; 58(1):168. DOI: 10.1002/ana.20525. View

Ricchi V, Zibetti M, Angrisano S, Merola A, Arduino N, Artusi C . Transient effects of 80 Hz stimulation on gait in STN DBS treated PD patients: a 15 months follow-up study. Brain Stimul. 2011; 5(3):388-392. DOI: 10.1016/j.brs.2011.07.001. View

Phibbs F, Arbogast P, Davis T . 60-Hz frequency effect on gait in Parkinson's disease with subthalamic nucleus deep brain stimulation. Neuromodulation. 2013; 17(8):717-20. PMC: 3999304. DOI: 10.1111/ner.12131. View

Lowry K, Lokenvitz N, Smiley-Oyen A . Age- and speed-related differences in harmonic ratios during walking. Gait Posture. 2011; 35(2):272-6. DOI: 10.1016/j.gaitpost.2011.09.019. View

10.

Sidiropoulos C, Walsh R, Meaney C, Poon Y, Fallis M, Moro E . Low-frequency subthalamic nucleus deep brain stimulation for axial symptoms in advanced Parkinson's disease. J Neurol. 2013; 260(9):2306-11. DOI: 10.1007/s00415-013-6983-2. View

11.

Moreau C, Defebvre L, Destee A, Bleuse S, Clement F, Blatt J . STN-DBS frequency effects on freezing of gait in advanced Parkinson disease. Neurology. 2008; 71(2):80-4. DOI: 10.1212/01.wnl.0000303972.16279.46. View

12.

Perera T, Tan J, Cole M, Yohanandan S, Silberstein P, Cook R . Balance control systems in Parkinson's disease and the impact of pedunculopontine area stimulation. Brain. 2018; 141(10):3009-3022. PMC: 6158752. DOI: 10.1093/brain/awy216. View

13.

Kavanagh J, Barrett R, Morrison S . Upper body accelerations during walking in healthy young and elderly men. Gait Posture. 2004; 20(3):291-8. DOI: 10.1016/j.gaitpost.2003.10.004. View

14.

Tan J, Perera T, McGinley J, Yohanandan S, Brown P, Thevathasan W . Neurophysiological analysis of the clinical pull test. J Neurophysiol. 2018; 120(5):2325-2333. PMC: 6314461. DOI: 10.1152/jn.00789.2017. View

15.

Cole M, Rippey J, Naughton G, Silburn P . Use of a Short-Form Balance Confidence Scale to Predict Future Recurrent Falls in People With Parkinson Disease. Arch Phys Med Rehabil. 2015; 97(1):152-6. DOI: 10.1016/j.apmr.2015.07.027. View

16.

Xie T, Vigil J, MacCracken E, Gasparaitis A, Young J, Kang W . Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD. Neurology. 2014; 84(4):415-20. PMC: 4336001. DOI: 10.1212/WNL.0000000000001184. View

17.

Menz H, Lord S, Fitzpatrick R . Acceleration patterns of the head and pelvis when walking on level and irregular surfaces. Gait Posture. 2003; 18(1):35-46. DOI: 10.1016/s0966-6362(02)00159-5. View

18.

Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin J, Pujol S . 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging. 2012; 30(9):1323-41. PMC: 3466397. DOI: 10.1016/j.mri.2012.05.001. View

19.

Conway Z, Silburn P, Thevathasan W, Maley K, Naughton G, Cole M . Alternate Subthalamic Nucleus Deep Brain Stimulation Parameters to Manage Motor Symptoms of Parkinson's Disease: Systematic Review and Meta-analysis. Mov Disord Clin Pract. 2019; 6(1):17-26. PMC: 6335519. DOI: 10.1002/mdc3.12681. View

20.

Bellanca J, Lowry K, Vanswearingen J, Brach J, Redfern M . Harmonic ratios: a quantification of step to step symmetry. J Biomech. 2013; 46(4):828-31. PMC: 4745116. DOI: 10.1016/j.jbiomech.2012.12.008. View