Low-Frequency Adaptive Deep Brain Stimulation for Parkinson's Disease

BackgroundFreezing of gait (FOG) is a debilitating symptom of Parkinsons disease (PD) that often worsens with disease progression. Adaptive deep brain stimulation (aDBS) may better target symptom fluctuations and gait impairment, yet most studies have focused on high-frequency stimulation. Low-frequency stimulation may offer additional gait benefits in moderate-to-advanced PD. ObjectiveTo evaluate the efficacy of 60 Hz continuous DBS (cDBS) and the safety, tolerability and feasibility of 60 Hz aDBS. MethodsEight individuals with PD were implanted with bilateral leads in the subthalamic nucleus and the investigational Summit RC+S system (Medtronic, Inc.). 60 Hz aDBS was calibrated to adjust stimulation amplitude based on prolonged beta bursts. Participants completed blinded, randomized testing during a validated FOG-eliciting stepping-in-place task under OFF DBS, 60 Hz cDBS, and 60 Hz aDBS. Cardinal motor signs were assessed using MDS-UPDRS III in each condition, and under clinical 140 Hz cDBS. Results60 Hz cDBS was tolerated acutely by 6 of 8 participants and showed significant shortening of beta burst duration, a pathological neural biomarker of FOG. 60 Hz aDBS was deemed safe and tolerable in this cohort. In participants who demonstrated FOG at baseline, gait improved ON both 60 Hz aDBS and cDBS. However, overall motor symptoms, including tremor, improved only with clinical 140 Hz cDBS. Conclusion60 Hz aDBS and cDBS benefit individuals with baseline FOG but may not achieve broad motor symptom relief of clinically optimized HFS. Identifying individuals most likely to benefit from LFS could enable more personalized DBS programming.