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From the Department of Clinical and Biological Neurosciences and INSERM U318 (Drs. Moro, Esselink, Xie, Hommel, Benabid, and Pollak), Joseph Fourier University, CHU de Grenoble, France; Department of Neurology (Dr. Moro), Niguarda Ca’ Granda Hospital, Milano, Italy; and Department of Neurology (Dr. Esselink), Academic Medical Center, Amsterdam, the Netherlands.
Address correspondence and reprint requests to Dr. Pierre Pollak, Department of Clinical and Biological Neurosciences, Joseph Fourier University of Grenoble, CHU, Service de Neurologie, BP 217 38043 Grenoble, France; e-mail: pierre.pollak{at}ujf-grenoble.fr
Background: The main advantage of deep brain stimulation (DBS) in the treatment of PD is that the electrical settings can be adjusted to optimize benefits and minimize adverse effects. The main objective of this study was to discover how varying these electrical parameters impacted on parkinsonian motor signs.
Methods: Twelve patients with PD with chronic bilateral subthalamic nucleus (STN) stimulation were selected. The authors evaluated the effects of a variation in the voltages, frequencies, and pulse widths on tremor, bradykinesia, and rigidity using two different paradigms: one in which the total electrical energy delivered was held constant, and one in which this was varied. Up to 26 parameter conditions were tested under double blind randomized conditions.
Results: Voltages 
3 V and frequencies 130 Hz led to the greatest improvement in all three parkinsonian signs. A rate of 5 Hz significantly worsened akinesia. The combination of the highest voltage with the narrowest pulse width was most effective.
Conclusions: This study confirms that the most beneficial effects induced by STN stimulation are obtained at high frequencies and that voltage is the most critical factor to obtain adequate alteration in STN activity. The mechanisms by which STN DBS improves parkinsonism remain speculative.
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