Managing Intractable Symptoms of Parkinson's Disease: A Nonsurgical Approach Employing Infralow Frequency Neuromodulation

• Published in: Frontiers in human neuroscience Vol. 16; p. 894781
• Main Authors: Legarda, Stella B., Michas-Martin, P. Andreas, McDermott, Dana
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 08.07.2022; Frontiers Media S.A
• Subjects: Astrocytes; Ataxia; Brain; Cognition; Cognition & reasoning; Constipation; Electrical stimuli; Exercise; freezing gait in Parkinson's disease; Gait; Genes; Globus pallidus; Human Neuroscience; Hypotheses; infralow frequency neuromodulation in Parkinson's disease; Levodopa; Movement disorders; Neurodegenerative diseases; Neuromodulation; Neurons; Parkinson's disease; parkinsonism; Physical activity; Physical fitness; Solitary tract nucleus; Subthalamic nucleus; Synuclein; uncontrolled symptoms of Parkinson's disease; uncontrolled tremors; freezing gait in Parkinson's disease; uncontrolled tremors; infralow frequency neuromodulation in Parkinson's disease; Parkinson's disease; parkinsonism; non-pharmacological option in advanced Parkinson's disease; uncontrolled symptoms of Parkinson's disease; cortical beta suppression
• ISSN: 1662-5161; 1662-5161
• DOI: 10.3389/fnhum.2022.894781

Clinical features range from hyposmia and constipation early in the disease to cogwheel rigidity, tremors, and bradykinesia (classic triad for clinical diagnosis of PD); and later still postural instability, ataxia, and freezing of gait (FOG) experienced by patients in advanced stages of PD (Jancovic, 2008); these are often refractory to standard medications and even DBS (Lilleeng et al., 2015). Hunter-gatherers are estimated to have engaged in four times the level of physical activity compared to modern humans, (O'Keefea et al., 2011) and vigorous, even moderate exercise is associated with a >30% reduction in risk of developing PD (Yang et al., 2015). Expression of the SNCA gene encoding for alpha-synuclein is low in astrocytes, however the alpha-synuclein from dying neurons is taken up by astrocytes, an attempt to remove and degrade alpha-synuclein to maintain a healthy environment for neuronal survival (Booth et al., 2017). Long term reports on DBS are in accord that subthalamic nucleus (STN)-DBS provides greater beneficial effects than globus pallidus internus (GPi)-DBS on symptoms in off periods, allowing for reduction of medications, whereas GPi-DBS has a better effect than STN-DBS on reducing levodopa-induced dyskinesias (Odekerken et al., 2013), and confers relatively less of an impact on cognition (Odekerken et al., 2016).