Effect of low-frequency deep brain stimulation on sensory thresholds in Parkinson's disease.
OBJECTIVE Chronic pain is a major distressing symptom of Parkinson's disease (PD) that is often undertreated. Subthalamic nucleus (STN) deep brain stimulation (DBS) delivers high-frequency stimulation (HFS) to patients with PD and has been effective in pain relief in a subset of these patients. However, up to 74% of patients develop new pain concerns while receiving STN DBS. Here the authors explore whether altering the frequency of STN DBS changes pain perception as measured through quantitative sensory testing (QST). METHODS Using QST, the authors measured thermal and mechanical detection and pain thresholds in 19 patients undergoing DBS via HFS, low-frequency stimulation (LFS), and off conditions in a randomized order. Testing was performed in the region of the body with the most pain and in the lower back in patients without chronic pain. RESULTS In the patients with chronic pain, LFS significantly reduced heat detection thresholds as compared with thresholds following HFS (p = 0.029) and in the off state (p = 0.010). Moreover, LFS resulted in increased detection thresholds for mechanical pressure (p = 0.020) and vibration (p = 0.040) compared with these thresholds following HFS. Neither LFS nor HFS led to changes in other mechanical thresholds. In patients without chronic pain, LFS significantly increased mechanical pain thresholds in response to the 40-g pinprick compared with thresholds following HFS (p = 0.032). CONCLUSIONS Recent literature has suggested that STN LFS can be useful in treating nonmotor symptoms of PD. Here the authors demonstrated that LFS modulates thermal and mechanical detection to a greater extent than HFS. Low-frequency stimulation is an innovative means of modulating chronic pain in PD patients receiving STN DBS. The authors suggest that STN LFS may be a future option to consider when treating Parkinson's patients in whom pain remains the predominant complaint.
Departments of 1 Neurosurgery and.
Abigail
A
Belasen
Departments of 1 Neurosurgery and.
Khizer
K
Rizvi
Departments of 1 Neurosurgery and.|Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, New York.
Lucy E
LE
Gee
Departments of 1 Neurosurgery and.
Philip
P
Yeung
Departments of 1 Neurosurgery and.
Julia
J
Prusik
Neurology, Albany Medical Center; and.
Adolfo
A
Ramirez-Zamora
Neurology, Albany Medical Center; and.
Era
E
Hanspal
Neurology, Albany Medical Center; and.
Priscilla
P
Paiva
Neurology, Albany Medical Center; and.
Jennifer
J
Durphy
Neurology, Albany Medical Center; and.
Charles E
CE
Argoff
Departments of 1 Neurosurgery and.|Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, New York.
Julie G
JG
Pilitsis
D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015331:Cohort Studies; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*
DBS = deep brain stimulation; HFS = high-frequency stimulation; LFS = low-frequency stimulation; PD = Parkinson disease; QST = quantitative sensory testing; STN = subthalamic nucleus; chronic pain; deep brain stimulation; functional neurosurgery; high-frequency stimulation; low-frequency stimulation; mechanical detection thresholds; pressure pain thresholds; quantitative sensory testing; thermal thresholds; vibratory detection