{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:16:03Z","timestamp":1791828963014,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,4,4]],"date-time":"2020-04-04T00:00:00Z","timestamp":1585958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>High\u2010frequency (130\u2013185 Hz) deep brain stimulation (DBS) of the subthalamic nucleus is more effective for appendicular than axial symptoms in Parkinson's disease (PD). Low\u2010frequency (60\u201380 Hz) stimulation (LFS) may reduce gait\/balance impairment but typically results in worsening appendicular symptoms. We created a \u201cdual\u2010frequency\u201d programming paradigm (interleave\u2010interlink, IL\u2010IL) to address both axial and appendicular symptoms. In IL\u2010IL, 2 overlapping LFS programs are applied to the DBS lead, with the overlapping area focused on the optimal cathode. The nonoverlapping area (LFS) is thought to reduce gait\/balance impairment, whereas the overlapping area (high\u2010frequency stimulation, HFS) aims to control appendicular symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a randomized, double\u2010blind crossover trial comparing patients\u2019 previously optimized IL\u2010IL and conventional HFS paradigms. Each arm was 2\u2009weeks in duration. The primary outcome measure was the patient\/caregiver Modified Clinical Global Impression Severity (CGI\u2010S). Secondary outcome measures included blinded motor evaluations, timed tests, patient\/caregiver questionnaires, and Personal KinetiGraphs (PKG).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010five patients were enrolled, and 20 completed. The patient\/caregiver CGI\u2010S for gait\/balance (<jats:italic>P<\/jats:italic> = 0.01) and appendicular symptom control (<jats:italic>P<\/jats:italic> = 0.001), and the blinded rater MDS\u2010UPDRS\u2010III (\u22125.22, <jats:italic>P<\/jats:italic> = 0.02), CGI\u2010S gait\/balance (<jats:italic>P<\/jats:italic> = 0.01), and CGI\u2010S speech (<jats:italic>P<\/jats:italic> = 0.02) were better while on IL\u2010IL. Scores on Parkinson's Disease Quality of Life (<jats:italic>P<\/jats:italic> = 0.002) and Freezing\u2010of\u2010Gait Questionnaires (<jats:italic>P<\/jats:italic> = 0.04) were better on IL\u2010IL. The Timed\u2010Up\u2010and\u2010Go was 9.8% faster (<jats:italic>P<\/jats:italic> = 0.01), with 11.8% reduction in steps (<jats:italic>P<\/jats:italic> = 0.001) on IL\u2010IL. There was no difference in PKG bradykinesia (<jats:italic>P<\/jats:italic> = 0.18) or tremor (<jats:italic>P<\/jats:italic> = 0.23) between paradigms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results prompt consideration of this novel programming paradigm (IL\u2010IL) for PD patients with axial symptom impairment as a new treatment option for <jats:italic>both<\/jats:italic> axial and appendicular symptoms. \u00a9 2020 International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.28048","type":"journal-article","created":{"date-parts":[[2020,4,4]],"date-time":"2020-04-04T10:05:31Z","timestamp":1585994731000},"page":"1369-1378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["A Novel <scp>DBS<\/scp> Paradigm for Axial Features in Parkinson's Disease: A Randomized Crossover Study"],"prefix":"10.1002","volume":"35","author":[{"given":"Jessica A.","family":"Karl","sequence":"first","affiliation":[{"name":"Movement Disorder Section of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bichun","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Movement Disorder Section of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Goetz","sequence":"additional","affiliation":[{"name":"Medtronic Brain Modulation  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo Verhagen","family":"Metman","sequence":"additional","affiliation":[{"name":"Movement Disorder Section of Neurological Sciences Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.182"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awq221"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-009-0076-2"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.252"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000303972.16279.46"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2014.10.011"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001184"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12131"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-014-7605-3"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.06.223"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005575"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000494983"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-019-0140-5"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","unstructured":"BartonB HallD. videoprotocols and techniques for Movement Disorders by Brandon R Barton. 2015 [video].","DOI":"10.1093\/med\/9780199948512.003.0017"},{"key":"e_1_2_8_16_1","unstructured":"VerhagenMetmanLFan WMyre BDansen MKartha NArzbaecherJ.Quantification of upper limb bradykinesia in Parkinson's disease. 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