Low-Frequency STN-DBS for Standing and Gait Initiation in Parkinson's Disease: A Double-Blinded Randomised Cross-Over Feasibility Trial.
Zachary J Conway, Peter A Silburn, Thushara Perera and 3 others
PMID 42240331WHAT IT FOUND
Switching to low-frequency brain stimulation improved standing balance and movement initiation in Parkinson's, but caused tremor to return in 10 of 16 patients off medication.
Clinical mobility scores did not change, so the benefit is only visible on specialised force-plate tests.
Key findings
01Low-frequency stimulation significantly reduced sway velocity during standing and increased medial-lateral sway area during the locomotion phase of gait initiation compared to high-frequency stimulation.
02There were no significant differences between low- and high-frequency stimulation in clinical measures of mobility (6-m walk, Timed Up and Go) or symptom severity (MDS-UPDRS III).
03Ten of the 16 participants experienced a re-emergence of resting tremor with low-frequency stimulation, and four of these were unable to complete the assessments.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was a small feasibility trial with only 16 participants analysed, limiting the generalisability of the findings. Participants were tested while off medication, which may not reflect their usual therapeutic state and could have exacerbated tremor during low-frequency stimulation. The wash-in period between conditions was only 60 minutes, which may not have been sufficient to eliminate carry-over effects, meaning results reflect acute rather than long-term responses. No correction for multiple statistical comparisons was applied, increasing the risk that some significant findings occurred by chance. The study did not compare the low-frequency state to the patient's pre-surgical baseline, so it is unclear if balance improved relative to before DBS was implanted.
Declared interests
The authors declared no potential conflicts of interest. Funding was provided by an Australian Government Research Training Program Scholarship.
The easy way to misread this
Do not interpret the improved force-plate sway measures as evidence that low-frequency DBS improves functional balance or reduces falls. Clinical mobility tests showed no difference between conditions, and the stimulation caused tremor to return in most participants when they were off medication.