Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease
Identifieur interne : 002362 ( Main/Corpus ); précédent : 002361; suivant : 002363Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease
Auteurs : Tao Xie ; Un Jung Kang ; Peter WarnkeSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2012-10.
Abstract
Background Patients with Parkinson's disease (PD) may develop freezing of gait (FOG) with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) at the commonly used frequency of 130 Hz and FOG can be ameliorated by 60 Hz stimulation in some patients. It is not clear whether the development of FOG is due to the disease progression or the chronic stimulation at this 130 Hz frequency. Aims To investigate the effect of stimulation frequency on immediate FOG in newly activated STN DBS patient with PD and determine if stimulation frequency alone could affect the FOG. Methods Two cases of PD who developed FOG immediately upon activation of the newly placed STN DBS were studied for the effect of stimulation frequency on FOG in both `off' and `on' medication status. Results Both patients developed severe FOG with the commonly used 130 Hz stimulation. Switching the frequency to 60 Hz immediately alleviated the FOG, without change in contacts, voltages and pulse widths. This frequency effect on FOG was present in both `off' and `on' statuses and remained effective during the 10-month follow-up period. Conclusion These two cases demonstrate that lower frequency stimulation of 60 Hz could improve FOG, while the commonly used 130 Hz stimulation could cause FOG or make it worse. In addition, the beneficial effect of low frequency DBS was additive to dopaminergic medication effect and included other axial symptoms.
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DOI: 10.1136/jnnp-2011-302091
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title><author><name sortKey="Xie, Tao" sort="Xie, Tao" uniqKey="Xie T" first="Tao" last="Xie">Tao Xie</name><affiliation><mods:affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: txie@bsd.uchicago.edu</mods:affiliation></affiliation></author><author><name sortKey="Kang, Un Jung" sort="Kang, Un Jung" uniqKey="Kang U" first="Un Jung" last="Kang">Un Jung Kang</name><affiliation><mods:affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Warnke, Peter" sort="Warnke, Peter" uniqKey="Warnke P" first="Peter" last="Warnke">Peter Warnke</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:DB803897F3B3535C220C39AD1C9EA513232DB602</idno><date when="2012" year="2012">2012</date><idno type="doi">10.1136/jnnp-2011-302091</idno><idno type="url">https://api.istex.fr/document/DB803897F3B3535C220C39AD1C9EA513232DB602/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">002362</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title><author><name sortKey="Xie, Tao" sort="Xie, Tao" uniqKey="Xie T" first="Tao" last="Xie">Tao Xie</name><affiliation><mods:affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: txie@bsd.uchicago.edu</mods:affiliation></affiliation></author><author><name sortKey="Kang, Un Jung" sort="Kang, Un Jung" uniqKey="Kang U" first="Un Jung" last="Kang">Un Jung Kang</name><affiliation><mods:affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Warnke, Peter" sort="Warnke, Peter" uniqKey="Warnke P" first="Peter" last="Warnke">Peter Warnke</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-10">2012-10</date><biblScope unit="volume">83</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1015">1015</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">DB803897F3B3535C220C39AD1C9EA513232DB602</idno><idno type="DOI">10.1136/jnnp-2011-302091</idno><idno type="href">jnnp-83-1015.pdf</idno><idno type="ArticleID">jnnp-2011-302091</idno><idno type="PMID">22696586</idno><idno type="local">jnnp;83/10/1015</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Patients with Parkinson's disease (PD) may develop freezing of gait (FOG) with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) at the commonly used frequency of 130 Hz and FOG can be ameliorated by 60 Hz stimulation in some patients. It is not clear whether the development of FOG is due to the disease progression or the chronic stimulation at this 130 Hz frequency. Aims To investigate the effect of stimulation frequency on immediate FOG in newly activated STN DBS patient with PD and determine if stimulation frequency alone could affect the FOG. Methods Two cases of PD who developed FOG immediately upon activation of the newly placed STN DBS were studied for the effect of stimulation frequency on FOG in both `off' and `on' medication status. Results Both patients developed severe FOG with the commonly used 130 Hz stimulation. Switching the frequency to 60 Hz immediately alleviated the FOG, without change in contacts, voltages and pulse widths. This frequency effect on FOG was present in both `off' and `on' statuses and remained effective during the 10-month follow-up period. Conclusion These two cases demonstrate that lower frequency stimulation of 60 Hz could improve FOG, while the commonly used 130 Hz stimulation could cause FOG or make it worse. In addition, the beneficial effect of low frequency DBS was additive to dopaminergic medication effect and included other axial symptoms.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Tao Xie</name><affiliations><json:string>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</json:string><json:string>E-mail: txie@bsd.uchicago.edu</json:string></affiliations></json:item><json:item><name>Un Jung Kang</name><affiliations><json:string>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</json:string></affiliations></json:item><json:item><name>Peter Warnke</name><affiliations><json:string>Department of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gait</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>stereotactic surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>electric stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Huntington's</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>neurogenetics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>neurosurgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>epilepsy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>neuro-oncology</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Background Patients with Parkinson's disease (PD) may develop freezing of gait (FOG) with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) at the commonly used frequency of 130 Hz and FOG can be ameliorated by 60 Hz stimulation in some patients. It is not clear whether the development of FOG is due to the disease progression or the chronic stimulation at this 130 Hz frequency. Aims To investigate the effect of stimulation frequency on immediate FOG in newly activated STN DBS patient with PD and determine if stimulation frequency alone could affect the FOG. Methods Two cases of PD who developed FOG immediately upon activation of the newly placed STN DBS were studied for the effect of stimulation frequency on FOG in both `off' and `on' medication status. Results Both patients developed severe FOG with the commonly used 130 Hz stimulation. Switching the frequency to 60 Hz immediately alleviated the FOG, without change in contacts, voltages and pulse widths. This frequency effect on FOG was present in both `off' and `on' statuses and remained effective during the 10-month follow-up period. Conclusion These two cases demonstrate that lower frequency stimulation of 60 Hz could improve FOG, while the commonly used 130 Hz stimulation could cause FOG or make it worse. In addition, the beneficial effect of low frequency DBS was additive to dopaminergic medication effect and included other axial symptoms.</abstract><qualityIndicators><score>5.387</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>12</keywordCount><abstractCharCount>1438</abstractCharCount><pdfWordCount>2115</pdfWordCount><pdfCharCount>12965</pdfCharCount><pdfPageCount>3</pdfPageCount><abstractWordCount>231</abstractWordCount></qualityIndicators><title>Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title><pmid><json:string>22696586</json:string></pmid><genre><json:string>brief communication</json:string></genre><host><volume>83</volume><pages><first>1015</first></pages><issn><json:string>0022-3050</json:string></issn><issue>10</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><publicationDate>2012</publicationDate><copyrightDate>2012</copyrightDate><doi><json:string>10.1136/jnnp-2011-302091</json:string></doi><id>DB803897F3B3535C220C39AD1C9EA513232DB602</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/DB803897F3B3535C220C39AD1C9EA513232DB602/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/DB803897F3B3535C220C39AD1C9EA513232DB602/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/DB803897F3B3535C220C39AD1C9EA513232DB602/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2012-06-13</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title><author corresp="yes"><persName><forename type="first">Tao</forename><surname>Xie</surname></persName><email>txie@bsd.uchicago.edu</email><affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</affiliation></author><author><persName><forename type="first">Un Jung</forename><surname>Kang</surname></persName><affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</affiliation></author><author><persName><forename type="first">Peter</forename><surname>Warnke</surname></persName><affiliation>Department of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-10"></date><biblScope unit="volume">83</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1015">1015</biblScope></imprint></monogr><idno type="istex">DB803897F3B3535C220C39AD1C9EA513232DB602</idno><idno type="DOI">10.1136/jnnp-2011-302091</idno><idno type="href">jnnp-83-1015.pdf</idno><idno type="ArticleID">jnnp-2011-302091</idno><idno type="PMID">22696586</idno><idno type="local">jnnp;83/10/1015</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012-06-13</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Patients with Parkinson's disease (PD) may develop freezing of gait (FOG) with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) at the commonly used frequency of 130 Hz and FOG can be ameliorated by 60 Hz stimulation in some patients. It is not clear whether the development of FOG is due to the disease progression or the chronic stimulation at this 130 Hz frequency. Aims To investigate the effect of stimulation frequency on immediate FOG in newly activated STN DBS patient with PD and determine if stimulation frequency alone could affect the FOG. Methods Two cases of PD who developed FOG immediately upon activation of the newly placed STN DBS were studied for the effect of stimulation frequency on FOG in both `off' and `on' medication status. Results Both patients developed severe FOG with the commonly used 130 Hz stimulation. Switching the frequency to 60 Hz immediately alleviated the FOG, without change in contacts, voltages and pulse widths. This frequency effect on FOG was present in both `off' and `on' statuses and remained effective during the 10-month follow-up period. Conclusion These two cases demonstrate that lower frequency stimulation of 60 Hz could improve FOG, while the commonly used 130 Hz stimulation could cause FOG or make it worse. In addition, the beneficial effect of low frequency DBS was additive to dopaminergic medication effect and included other axial symptoms.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Movement disorders</term></item><item><term>Parkinson's disease</term></item><item><term>gait</term></item><item><term>stereotactic surgery</term></item><item><term>electric stimulation</term></item><item><term>Huntington's</term></item><item><term>neurogenetics</term></item><item><term>neurosurgery</term></item><item><term>epilepsy</term></item><item><term>surgery</term></item><item><term>neuro-oncology</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2012-06-13">Created</change><change when="2012-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/DB803897F3B3535C220C39AD1C9EA513232DB602/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="brief-report"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2011-302091</article-id><article-id pub-id-type="doi">10.1136/jnnp-2011-302091</article-id><article-id pub-id-type="other">jnnp;83/10/1015</article-id><article-id pub-id-type="other">jnnp;jnnp-2011-302091</article-id><article-id pub-id-type="pmid">22696586</article-id><article-id pub-id-type="other">1015</article-id><article-id pub-id-type="other">jnnp-2011-302091</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><series-title>Short report</series-title></article-categories><title-group><article-title>Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Xie</surname><given-names>Tao</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kang</surname><given-names>Un Jung</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Warnke</surname><given-names>Peter</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</aff><aff id="aff2"><label>2</label>Department of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA</aff><author-notes><corresp><label>Correspondence to</label> Dr Tao Xie, Assistant Professor, Department of Neurology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2030, Chicago, IL 60637, USA; <email>txie@bsd.uchicago.edu</email></corresp></author-notes><pub-date pub-type="epub-original"><day>13</day><month>6</month><year>2012</year></pub-date><pub-date pub-type="ppub"><month>10</month><year>2012</year></pub-date><pub-date pub-type="epub"><day>13</day><month>6</month><year>2012</year></pub-date><volume>83</volume><volume-id pub-id-type="other">83</volume-id><volume-id pub-id-type="other">83</volume-id><issue>10</issue><issue-id pub-id-type="other">jnnp;83/10</issue-id><issue-id pub-id-type="other">10</issue-id><issue-id pub-id-type="other">83/10</issue-id><fpage>1015</fpage><history><date date-type="received"><day>21</day><month>12</month><year>2011</year></date><date date-type="rev-recd"><day>15</day><month>4</month><year>2012</year></date><date date-type="accepted"><day>18</day><month>4</month><year>2012</year></date></history><permissions><copyright-statement>© 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2012</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-83-1015.pdf"></self-uri><abstract><sec><title>Background</title><p>Patients with Parkinson's disease (PD) may develop freezing of gait (FOG) with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) at the commonly used frequency of 130 Hz and FOG can be ameliorated by 60 Hz stimulation in some patients. It is not clear whether the development of FOG is due to the disease progression or the chronic stimulation at this 130 Hz frequency.</p></sec><sec><title>Aims</title><p>To investigate the effect of stimulation frequency on immediate FOG in newly activated STN DBS patient with PD and determine if stimulation frequency alone could affect the FOG.</p></sec><sec><title>Methods</title><p>Two cases of PD who developed FOG immediately upon activation of the newly placed STN DBS were studied for the effect of stimulation frequency on FOG in both `off' and `on' medication status.</p></sec><sec><title>Results</title><p>Both patients developed severe FOG with the commonly used 130 Hz stimulation. Switching the frequency to 60 Hz immediately alleviated the FOG, without change in contacts, voltages and pulse widths. This frequency effect on FOG was present in both `off' and `on' statuses and remained effective during the 10-month follow-up period.</p></sec><sec><title>Conclusion</title><p>These two cases demonstrate that lower frequency stimulation of 60 Hz could improve FOG, while the commonly used 130 Hz stimulation could cause FOG or make it worse. In addition, the beneficial effect of low frequency DBS was additive to dopaminergic medication effect and included other axial symptoms.</p></sec></abstract><kwd-group><kwd>Movement disorders</kwd><kwd>Parkinson's disease</kwd><kwd>gait</kwd><kwd>stereotactic surgery</kwd><kwd>electric stimulation</kwd><kwd>Huntington's</kwd><kwd>neurogenetics</kwd><kwd>neurosurgery</kwd><kwd>epilepsy</kwd><kwd>surgery</kwd><kwd>neuro-oncology</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Short report</partName><title>Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Short report</partName><title>Effect of stimulation frequency on immediate freezing of gait in newly activated STN DBS in Parkinson's disease</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Tao</namePart><namePart type="family">Xie</namePart><affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</affiliation><affiliation>E-mail: txie@bsd.uchicago.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Un Jung</namePart><namePart type="family">Kang</namePart><affiliation>Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Peter</namePart><namePart type="family">Warnke</namePart><affiliation>Department of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="brief communication" displayLabel="brief-report"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2012-10</dateIssued><dateCreated encoding="w3cdtf">2012-06-13</dateCreated><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background Patients with Parkinson's disease (PD) may develop freezing of gait (FOG) with chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) at the commonly used frequency of 130 Hz and FOG can be ameliorated by 60 Hz stimulation in some patients. It is not clear whether the development of FOG is due to the disease progression or the chronic stimulation at this 130 Hz frequency. Aims To investigate the effect of stimulation frequency on immediate FOG in newly activated STN DBS patient with PD and determine if stimulation frequency alone could affect the FOG. Methods Two cases of PD who developed FOG immediately upon activation of the newly placed STN DBS were studied for the effect of stimulation frequency on FOG in both `off' and `on' medication status. Results Both patients developed severe FOG with the commonly used 130 Hz stimulation. Switching the frequency to 60 Hz immediately alleviated the FOG, without change in contacts, voltages and pulse widths. This frequency effect on FOG was present in both `off' and `on' statuses and remained effective during the 10-month follow-up period. Conclusion These two cases demonstrate that lower frequency stimulation of 60 Hz could improve FOG, while the commonly used 130 Hz stimulation could cause FOG or make it worse. In addition, the beneficial effect of low frequency DBS was additive to dopaminergic medication effect and included other axial symptoms.</abstract><subject><genre>Keywords</genre><topic>Movement disorders</topic><topic>Parkinson's disease</topic><topic>gait</topic><topic>stereotactic surgery</topic><topic>electric stimulation</topic><topic>Huntington's</topic><topic>neurogenetics</topic><topic>neurosurgery</topic><topic>epilepsy</topic><topic>surgery</topic><topic>neuro-oncology</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>83</number></detail><detail type="issue"><caption>no.</caption><number>10</number></detail><extent unit="pages"><start>1015</start></extent></part></relatedItem><identifier type="istex">DB803897F3B3535C220C39AD1C9EA513232DB602</identifier><identifier type="DOI">10.1136/jnnp-2011-302091</identifier><identifier type="href">jnnp-83-1015.pdf</identifier><identifier type="ArticleID">jnnp-2011-302091</identifier><identifier type="PMID">22696586</identifier><identifier type="local">jnnp;83/10/1015</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2012, Published by the BMJ Publishing Group Limited. 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