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This Article Figures Only Full Text Full Text (PDF) Take the CME quiz CME: Take the course for this article: Volume 71, Number 2, July 8, 2008 Data Supplement All Versions of this Article: 01.wnl.0000303972.16279.46v1 71/2/80    most recent Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Moreau, C. Articles by Devos, D. Search for Related Content PubMed PubMed Citation Articles by Moreau, C. Articles by Devos, D. Related Collections Parkinson's disease/Parkinsonism

STN-DBS frequency effects on freezing of gait in advanced Parkinson disease

From the Department of Neurology and Movement Disorders (C.M., L.D., A.D., P.K., D.D.) and Department of Clinical Neurophysiology (S.B., J.L.B.), EA 2683, IFR 114, University of Lille 2, Lille, France; and Department of Neurology (F.C.), Roeselare, H.-Hartziekenhuis Roeselaere-Menen, Belgium.

Address correspondence and reprint requests to Dr. David Devos, Clinique Neurologique, Hôpital R. Salengro, CHU, F-59037 Lille cedex, France d-devos{at}chru-lille.fr

Background: Severe gait disturbances and freezing episodes (frequently resistant to optimal dopaminergic treatment) often appear in advanced Parkinson disease (PD). Even several years after initiation, high-frequency subthalamic nucleus deep brain stimulation (STN-DBS) is still very effective for controlling segmental symptoms. However, there are no long-term data on the management of gait disorders and freezing in STN-DBS.

Objectives: To compare the effects of various STN-DBS parameters on freezing of gait and to determine whether such effects are more related to stimulation energy (usual voltages vs high voltages at 130 Hz) or frequency (130 Hz vs approximately half this frequency: 60 Hz).

Methods: We blindly assessed STN-DBS parameters in 13 PD patients reporting severe gait disorders. We compared the effects on gait of two different voltages (the patient’s usual voltage [median 3 volts] and a high voltage [median 3.7 volts]) and two different frequencies (60 and 130 Hz, while maintaining the same total energy delivered) vs "off-stimulation" conditions.

Results: The number of freezing episodes was significantly lower at the 60-Hz "high voltage/equivalent energy" and higher at the 130-Hz/high voltage than for "off stimulation." The slight improvement in the Unified Parkinson’s Disease Rating Scale motor score observed (at 130 Hz) did not achieve statistical significance.

Conclusions: Our results prompt consideration of a new strategy for two-stage subthalamic nucleus deep brain stimulation (STN-DBS) frequency optimization, with stimulation at 130 Hz and the usual voltage during the initial years of STN-DBS and then at 60 Hz at a high voltage in Parkinson disease patients who develop severe gait disorders.

Abbreviations: DBS = deep brain stimulation; MLA = mesencephalic locomotor area; PD = Parkinson disease; PPN = pedunculopontine nucleus; Q1 = first quartile; Q3 = third quartile; STN = subthalamic nucleus; SWS = Stand–Walk–Sit; TEED = total electrical energy delivered; UPDRS = Unified Parkinson’s Disease Rating Scale.

Supplemental data at www.neurology.org

Editorial, page 76

e-Pub ahead of print on April 16, 2008, at www.neurology.org.

Disclosure: The authors report no disclosures.

Received June 1, 2007. Accepted in final form November 7, 2007.

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