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 freezin...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.展开更多
Deep brain stimulation(DBS)in the thalamic ventrointermediate nucleus(VIM)is the traditional target for the surgical treatment of pharmacologically refractory essential tremor or parkinsonian tremor.Studies in recent ...Deep brain stimulation(DBS)in the thalamic ventrointermediate nucleus(VIM)is the traditional target for the surgical treatment of pharmacologically refractory essential tremor or parkinsonian tremor.Studies in recent years on DBS in posterior subthalamic area(PSA),including the zona incerta and the prelemniscal radiation,have shown promising results in tremor suppression,particularly for those tremors difficult to be well controlled by VIM DBS,such as the proximal postural tremor,distal intention tremor and some cerebellar outflow tremor in various diseases including essential tremor and multiple sclerosis.The adverse effect profile of the PSA DBS is mild and transient,without lasting or striking dysarthria,disequilibrium or tolerance,in contrast to VIM DBS,particularly bilateral DBS.However,the studies on PSA DBS so far are still limited,with a handful of studies on bilateral PSA,and a short follow up duration compared to VIM.More studies are needed for direct comparison of these targets in the future.A review here would help to gain more insight into the benefits and limits of the PSA DBS compared to that in VIM in the clinical management of various tremors,particularly for those difficult to be well controlled by traditional VIM DBS.展开更多
文摘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.
文摘Deep brain stimulation(DBS)in the thalamic ventrointermediate nucleus(VIM)is the traditional target for the surgical treatment of pharmacologically refractory essential tremor or parkinsonian tremor.Studies in recent years on DBS in posterior subthalamic area(PSA),including the zona incerta and the prelemniscal radiation,have shown promising results in tremor suppression,particularly for those tremors difficult to be well controlled by VIM DBS,such as the proximal postural tremor,distal intention tremor and some cerebellar outflow tremor in various diseases including essential tremor and multiple sclerosis.The adverse effect profile of the PSA DBS is mild and transient,without lasting or striking dysarthria,disequilibrium or tolerance,in contrast to VIM DBS,particularly bilateral DBS.However,the studies on PSA DBS so far are still limited,with a handful of studies on bilateral PSA,and a short follow up duration compared to VIM.More studies are needed for direct comparison of these targets in the future.A review here would help to gain more insight into the benefits and limits of the PSA DBS compared to that in VIM in the clinical management of various tremors,particularly for those difficult to be well controlled by traditional VIM DBS.
