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Clinical and neurophysiological assessment of DBS frequency

Zacharia, André; (2021) Clinical and neurophysiological assessment of DBS frequency. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Deep brain stimulation is a surgical treatment for patients with advanced Parkin son’s disease whose symptoms have become challenging to control with available drug therapy. It involves implanting electrodes bilaterally into the subthalamic nu clei and then connecting them to a stimulator placed under the skin in the thoracic area. Several stimulation parameters can be adjusted to produce the best clinical effect, namely: frequency, pulse width, and voltage. After several years of DBS, many patients develop postural instability, gait, and speech disorders. Those prob lems have been attributed to disease progression. Nevertheless, recent studies have shown that they might improve using a lower frequency of stimulation than the one commonly used. We have decided to conduct this thesis to try to understand better the role of the DBS frequency. We looked at the effect of 80Hz vs. 130Hz. We have per formed four studies exploring different domains. Fifteen patients were randomized in a cross-over trial to receive 3 weeks of stimulation at 80 Hz and 130 Hz. Study 1 was dedicated to assessing the motor outcome, which showed that: a) overall clinical scores were unchanged and stable throughout the trial, b) proximal and complex movements were slightly improved at 80Hz, but more distal movements were improved at 130 Hz. Study 2 analyzed the cognitive aspects and showed an improvement of 80 Hz on phonetic fluency but not on semantic fluency. Study 3: looked at the neurophysiological aspects: various paradigms assessed cortical ex citability by transcranial magnetic stimulation (TMS): short intracortical inhibition ended up being more physiological at 130Hz. Study 4 was performed to compare saccades and antisaccades’ performances at 80 and 130Hz, respectively. 21 patients and 16 matched healthy controls (HC) were enrolled: saccades were facilitated at 80Hz instead of 130Hz; however, more errors were seen.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Clinical and neurophysiological assessment of DBS frequency
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery.ucl.ac.uk/id/eprint/10132916
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