Theta-frequency subthalamic nucleus deep brain stimulation selectively improves visual attention in Parkinson’s disease
TL;DR
Theta-frequency STN-DBS selectively improves visual attention in PD with pre-existing attentional deficits, likely by enhancing top-down attentional resource allocation, while high-frequency stimulation impairs performance.
Abstract
Objective Visual attention deficits are common but under-recognized in Parkinson’s disease (PD), and we investigate whether theta-frequency (5 Hz) STN-DBS differentially modulates visual attention compared with high-frequency (130 Hz) stimulation in PD patients. Methods Thirty-nine PD patients with bilateral STN-DBS perform an attentional capture task under three stimulation conditions (OFF, low-frequency, high-frequency). Patients are stratified into impaired (n = 21) and normal (n = 18) visual attention groups based on their accuracy in the AC-distractor task during OFF-stimulation, with <90% accuracy defining impairment. Behavioral accuracy and reaction time are analyzed using Bayesian mixed-effects models. P300 amplitudes and latencies are measured using electroencephalography. Results In the impaired group, 5 Hz stimulation significantly improves accuracy in the distractor condition compared with OFF (BF > 1,000), whereas 130 Hz stimulation reduces accuracy (BF = 122.8). This behavioral pattern is paralleled by enhanced P300 amplitude and prolonged latency under 5 Hz stimulation, and suppressed P300 amplitude under 130 Hz stimulation. No significant stimulation effects are observed in the normal group. Conclusion Theta-frequency STN-DBS selectively improves visual attention in PD with pre-existing attentional deficits, likely by enhancing top-down attentional resource allocation, while high-frequency stimulation impairs performance.