Comparing the impact of low frequency vs high frequency deep brain stimulation in Patient’s with Parkinson’s disease: A systematic review

Aim

Deep brain stimulation (DBS) involves implanting electrodes in specific brain areas. High-frequency Stimulation (HFS) and low-frequency Stimulation (LFS) target motor and non-motor symptoms differently. DBS is crucial in Parkinson's disease (PD) treatment for managing medication-resistant symptoms and improving quality of life. This review aims to evaluate the differential impact of high-frequency and low-frequency DBS on motor symptoms in PD patients. This systematic review adheres to PRISMA guidelines and focuses on clinical studies involving human subjects.

Methods

Systematic search in electronic databases (PubMed, Google Scholar, Science Direct, Cochrane Collaboration Database of Randomized Trials) was performed to identify randomized controlled trials (RCTs) up to 13th July 2024.

Results

Among 126 pooled patients from 8 RCTs, it was found that LFS significantly improved gait stability, swallowing, and verbal fluency with minimal adverse effects. Conversely, HFS was effective in reducing rigidity and tremor but was associated with potential side effects such as gait and speech impairment.

Conclusion

This review underscores the frequency dependent effects of Subthalamic Nucleus DBS (STN-DBS) in PD. High-frequency stimulation (>100 Hz) remains effective for controlling tremor and rigidity but is often associated with adverse effects. In contrast, low-frequency stimulation (≤100 Hz) shows a lower risk of these adverse effects, though it may be less effective for core motor symptoms. An optimal therapeutic window between 80 and 130 Hz may balance efficacy and tolerability. These findings support the need for individualized DBS programming and future research on adaptive stimulation technologies to optimize patient-specific outcomes.