Low-frequency STN-DBS provides acute gait improvements in Parkinson’s disease: a double-blinded randomised cross-over feasibility trial

Journal article

Conway, Zachary J., Silburn, Peter A., Perera, Thushara, O’Maley, Karen and Cole, Michael H.. (2021). Low-frequency STN-DBS provides acute gait improvements in Parkinson’s disease: a double-blinded randomised cross-over feasibility trial. Journal of NeuroEngineering and Rehabilitation. 18(1), p. Article: 125. https://doi.org/10.1186/s12984-021-00921-4

Publication dates
Authors	Conway, Zachary J., Silburn, Peter A., Perera, Thushara, O’Maley, Karen and Cole, Michael H.
Abstract	Background Some people with Parkinson’s disease (PD) report poorer dynamic postural stability following high-frequency deep brain stimulation of the subthalamic nucleus (STN-DBS), which may contribute to an increased falls risk. However, some studies have shown low-frequency (60 Hz) STN-DBS improves clinical measures of postural stability, potentially providing support for this treatment. This double-blind randomised crossover study aimed to investigate the effects of low-frequency STN-DBS compared to high-frequency stimulation on objective measures of gait rhythmicity in people with PD. Methods During high- and low-frequency STN-DBS and while off-medication, participants completed assessments of symptom severity and walking (e.g., Timed Up-and-Go). During comfortable walking, the harmonic ratio, an objective measures of gait rhythmicity, was derived from head- and trunk-mounted accelerometers to provide insight in dynamic postural stability. Lower harmonic ratios represent less rhythmic walking and have discriminated people with PD who experience falls. Linear mixed model analyses were performed on fourteen participants. Results Low-frequency STN-DBS significantly improved medial–lateral and vertical trunk rhythmicity compared to high-frequency. Improvements were independent of electrode location and total electrical energy delivered. No differences were noted between stimulation conditions for temporal gait measures, clinical mobility measures, motor symptom severity or the presence of gait retropulsion. Conclusions This study provides evidence for the acute benefits of low-frequency stimulation for gait outcomes in STN-DBS PD patients, independent of electrode location. However, the perceived benefits of this therapy may be diminished for people who experienced significant tremor pre-operatively, as lower frequencies may cause these symptoms to re-emerge. Trial registration: This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry on 5 June 2018 (ACTRN12618000944235).
Keywords	UPDRS; walk; rhythmic; sensor; balance
Year	2021
Journal	Journal of NeuroEngineering and Rehabilitation
Journal citation	18 (1), p. Article: 125
Publisher	Biomed Central Ltd
ISSN	1743-0003
Digital Object Identifier (DOI)	https://doi.org/10.1186/s12984-021-00921-4
PubMed ID	34376190
Scopus EID	2-s2.0-85112312856
PubMed Central ID	PMC8353795
Open access	Published as ‘gold’ (paid) open access
Research or scholarly	Research
Page range	1-11
Publisher's version	OA_Conway_2021_Low-frequency_STN-DBS_provides_acute.pdf License CC BY File Access Level Open
Output status	Published
Online	10 Aug 2021
Publication process dates
Accepted	02 Aug 2021
Deposited	22 Nov 2021

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Kerr, Graham K., Cole, Michael, Wood, Joanne M. and Silburn, Peter A.. (2012). A secondary motor task exaggerates gait deficits in Parkinson's fallers. Congress of the International Society of Electrophysiology & Kinesiology. International Society of Electrophysiology & Kinesiology.

How well do clinical tests predict future falls in older people?

Kerr, Graham K., Wood, Joanne M., Lacherez, Philippe F. and Cole, Michael H.. (2012). How well do clinical tests predict future falls in older people?

Cognitive function and postural instability in people with Parkinson's disease

Xu, Dong, Cole, Michael, Mengersen, Kerrie, Silburn, Peter and Kerr, Graham. (2012). Cognitive function and postural instability in people with Parkinson's disease.

Hamstring asymmetry: The key to recurring injury

Hill, Cameron and Cole, Michael. (2012). Hamstring asymmetry: The key to recurring injury.

A spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation

Thevathasan, Wesley, Cole, Michael H., Graepel, Cara L., Hyam, Jonathan A., Jenkinson, Ned, Brittain, John-Stuart, Coyne, Terry J., Silburn, Peter A., Aziz, Tipu Z., Kerr, Graham K. and Brown, Peter. (2012). A spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation. Brain. 135, pp. 1446 - 1454. https://doi.org/10.1093/brain/aws039

Performance of a secondary motor task reveals altered gait patterns in future Parkinson's fallers

Kerr, Graham K., Cole, Michael H., Wood, Joanne M. and Silburn, Peter A.. (2012). Performance of a secondary motor task reveals altered gait patterns in future Parkinson's fallers.

Pedunculopontine nucleus deep brain stimulation produces sustained improvement in primary progressive freezing of gait

Wilcox, Robert A., Cole, Michael H., Wong, David, Coyne, Terry, Silburn, Peter and Kerr, Graham. (2011). Pedunculopontine nucleus deep brain stimulation produces sustained improvement in primary progressive freezing of gait. Journal of Neurology, Neurosurgery and Psychiatry. 82(11), pp. 1256 - 1259. https://doi.org/10.1136/jnnp.2010.213462

Falls in Parkinson's disease: Evidence for altered stepping strategies on compliant surfaces

Cole, Michael H., Silburn, Peter A., Wood, Joanne M. and Kerr, Graham K.. (2011). Falls in Parkinson's disease: Evidence for altered stepping strategies on compliant surfaces. Parkinsonism and Related Disorders. 17(8), pp. 610 - 616. https://doi.org/10.1016/j.parkreldis.2011.05.019

Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration

Wood, Joanne M., Lacherez, Philippe, Black, Alex A., Cole, Michael H., Boon, Mei Ying and Kerr, Graham K.. (2011). Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Investigative Ophthalmology and Visual Science. 52(8), pp. 5088 - 5092. https://doi.org/10.1167/iovs.10-6644

Falls in Parkinson's disease: Kinematic evidence for impaired head and trunk control

Cole, Michael H., Silburn, Peter A., Wood, Joanne M., Worringham, Charles J. and Kerr, Graham K.. (2010). Falls in Parkinson's disease: Kinematic evidence for impaired head and trunk control. Movement Disorders. 25(14), pp. 2369 - 2378. https://doi.org/10.1002/mds.23292

Postural stability and gait among older adults with age-related maculopathy

Wood, Joanne M., Lacherez, Philippe F., Black, Alex A., Cole, Michael H., Boon, Mei Ying and Kerr, Graham K.. (2009). Postural stability and gait among older adults with age-related maculopathy. Investigative Ophthalmology and Visual Science. 50(1), pp. 482 - 487. https://doi.org/10.1167/iovs.08-1942