title: Sixty-hertz stimulation improves bradykinesia and amplifies subthalamic low-frequency oscillations.
abstract: The objective of this study was to investigate the hypothesis that attenuation of subthalamic nucleus (STN) alpha-/beta-band oscillations is causal to improvement in bradykinesia.
  
  
  
  STN local field potentials from a sensing neurostimulator (Activa®PC+S; Medtronic, Inc.) and kinematics from wearable sensors were recorded simultaneously during 60- and 140-Hz deep brain stimulation (DBS) in 9 freely moving PD subjects (15 STNs) performing repetitive wrist flexion-extension. Kinematics were recorded during 20-Hz DBS in a subgroup.
  
  
  
  Both 60- and 140-Hz DBS improved the angular velocity and frequency of movement (P = 0.002 and P = 0.029, respectively, for 60 Hz; P < 0.001 and P < 0.001, respectively, for 140 Hz), but 60-Hz DBS did not attenuate beta-band power (13-30 Hz). In fact, 60-Hz DBS amplified alpha/low-beta (11-15 Hz, P = 0.007) and attenuated high-beta power (19-27 Hz, P < 0.001), whereas 140-Hz DBS broadly attenuated beta power (15-30 Hz, P < 0.001). Only 60-Hz DBS improved the regularity of angular range (P = 0.046) and 20-Hz DBS did not worsen bradykinesia. There was no correlation between beta-power modulation and bradykinesia.
  
  
  
  These novel results obtained from freely moving PD subjects demonstrated that both 140- and 60-Hz DBS improved bradykinesia and attenuated high beta oscillations; however, 60-Hz DBS amplified a subband of alpha/low-beta oscillations, and DBS at a beta-band frequency did not worsen bradykinesia. Based on recent literature, we suggest that both 140- and 60-Hz DBS decouple the cortico-STN hyperdirect pathway, whereas 60-Hz DBS increases coupling within striato-STN circuitry. These results inform future algorithms for closed-loop DBS in PD. © 2016 International Parkinson and Movement Disorder Society.
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Zack
authors.initials: Z
authors.lastname: Blumenfeld
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Mandy Miller
authors.initials: MM
authors.lastname: Koop
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Prieto
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Shreve
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Anca
authors.initials: A
authors.lastname: Velisar
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Quinn
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.
authors.forename: Megan H
authors.initials: MH
authors.lastname: Trager
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.|Department of Neurosurgery, Stanford University, Stanford, California, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Brontë-Stewart
mesh_terms: D000368:Aged; D000513:Alpha Rhythm / Q000502:physiology*; D001611:Beta Rhythm / Q000502:physiology*; D046690:Deep Brain Stimulation / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D018476:Hypokinesia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology*
keywords: Parkinson's disease; beta oscillations; deep brain stimulation; low frequency; subthalamic nucleus