Effect of frequency on subthalamic nucleus deep brain stimulation in primary dystonia.
BACKGROUND
Subthalamic nucleus deep brain stimulation (DBS) is an alternative target choice for treating primary dystonia, but little is known about the most effective programming parameters.


OBJECTIVE
Here we prospectively evaluate the effect of low versus high frequency subthalamic nucleus DBS in patients with predominantly cervical or upper extremity primary dystonia.


METHODS
Seven patients were stimulated at low frequency stimulation (60 Hz) for the first three months and then switched to high frequency stimulation (130 Hz) until month six. Severity of dystonia was determined by a blinded rater (unaware of the patient's pre or post-operative status) who scored the Burke Fahn Marsden dystonia rating scale movement score (BFMDRS-M) and the Toronto Western Spasmodic Torticollis Rating Scale severity score (TWSTRS-S) preoperatively, three, six, and twelve months post-surgery.


RESULTS
Patients had a lower mean improvement of 16.6% in BFMDRS-M and 9.5% in TWSTRS-S at three months using low frequency stimulation compared to a 52.3% (p = 0.018) and 45.2% (p = 0.028), respectively, noted at six months using high frequency stimulation. At 12 months (using 130 Hz), the BFMDRS-M and TWSTRS-S improved by 51.8% (p = 0.022) and 56% (p = 0.034). Patients developed transient dyskinesia (during low and high frequency stimulation) which improved with programming adjustments.


CONCLUSIONS
This study offers further support of the effectiveness of subthalamic nucleus DBS in the treatment of primary dystonia and finds that high frequency stimulation was more effective than low frequency stimulation.
Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA. Electronic address: jill.ostrem@ucsf.edu.
Jill L
JL
Ostrem
Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA.
Leslie C
LC
Markun
Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA.
Graham A
GA
Glass
Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Rm. M779, San Francisco, CA 94143, USA.
Caroline A
CA
Racine
Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA.
Monica M
MM
Volz
Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA.
Susan L
SL
Heath
Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Rm. M779, San Francisco, CA 94143, USA.
Coralie
C
de Hemptinne
Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Rm. M779, San Francisco, CA 94143, USA; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA.
Philip A
PA
Starr
D000293:Adolescent; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020531:Subthalamic Nucleus / Q000503:physiopathology; D016896:Treatment Outcome
Deep brain stimulation; Frequency; Primary dystonia; Subthalamic nucleus