Objective: We aimed to display if differentiated frequency can improve the tremor in patients with STN-DBS.

Background: Subthalamic deep brain stimulation (STN-DBS) is the best treatment for motor fluctuations in Parkinson’s disease (PD).  High-frequency stimulation (HFS) (i.e. from 130 Hz) is classically the best choice to control the segmental PD symptoms. Higher frequencies (i.e. 130-180 Hz) can further improve the tremor. However, HFS may also have slight differential effect on akinesia and tremor, but can also worsen some symptoms as gait or dysarthria. Cartesia-Boston® system for STN-DBS (Vercise Cartesia™ Directional Lead, Boston Scientific, Valencia, CA, USA) allows configuring different frequency stimulation between left and right sides. As the motor symptoms of the PD are asymmetrical.

Method: Postoperatively, after one year, 17 PD patients with STN-DBS were assessed in 4 conditions (stimulation on/medication off, stimulation off/medication off, stimulation off/medication on, stimulation on/medication on). Four (age between 56 and 68 years old; H/F= 3/1; disease duration between 12 and 25 years old) were not satisfied because of a persistent asymmetrical tremor. Differentiated frequency was proposed with higher frequency to control the tremor.

Results: Differentiated HFS (185 Hz vs 140 Hz for 3 patients, 174 Hz vs 130 Hz for the last one) reduced the tremor subscore and clinical global impression for 3 patients in comparison with symmetrical HFS (130 Hz bilaterally). No worsening of the total MDS-UPDRS III was highlighted.

Conclusion: Differentiated HFS is an option to reduce tremor in STN-DBS patients. More studies are needed to assess which profile of PD patients could benefit from it.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-we-customize-tune-for-asymmetric-tremor-with-differentiated-deep-brain-stimulation-frequencies/