Effects of Different STN-DBS Programming Strategies on Non-Motor Symptoms in Parkinson’s Disease: A Retrospective Controlled Study

Chang Liu,1 Jin Xu,2 Shuangfa Mao,3 Pengjie Li,4 Fangfang Lai2 1Department of Neurosurgery, Zigong First People’s Hospital, Zigong, Sichuan, People’s Republic of China; 2School of Clinical Medical Technology, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, People’s Republic of China; 3School of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, People’s Republic of China; 4School of Rehabilitation, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, People’s Republic of ChinaCorrespondence: Chang Liu, Department of Neurosurgery, Zigong First People’s Hospital, No. 42, Shangyihao First Road, Wuxing, Ziliujing, Zigong, Sichuan, 634000, People’s Republic of China, Email [email protected]: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms in Parkinson’s disease (PD), but optimal programming strategies for non-motor symptom management remain unclear. This study compared the effects of high-frequency versus low-frequency stimulation on sleep disorders, cognitive function, and mood disturbances.Methods: We conducted a retrospective controlled study of 80 PD patients who underwent bilateral STN-DBS between September 2023 and May 2025. Patients were divided into high-frequency (130– 185 Hz, n=40) and low-frequency (60– 80 Hz, n=40) groups based on their programming parameters. Sleep quality (Parkinson’s Disease Sleep Scale, PDSS), cognitive function (Montreal Cognitive Assessment, MoCA), anxiety (Hamilton Anxiety Scale, HAMA), and depression (Hamilton Depression Scale, HAMD) were assessed at baseline and at 3, 6, and 12 months post-surgery. Linear mixed-effects models analyzed longitudinal changes.Results: Both groups showed significant motor improvement (UPDRS-III reduction > 50%, p< 0.001). The low-frequency group demonstrated superior improvements in PDSS scores compared to high-frequency stimulation (mean difference at 12 months: 4.82 points, 95% CI: 2.15– 7.49, p< 0.001). HAMA scores improved more in the low-frequency group (mean difference: 2.34 points, 95% CI: 0.87– 3.81, p=0.002). MoCA scores remained stable in both groups with no significant between-group differences (p=0.421). HAMD improvements were comparable between groups (p=0.156).Conclusion: Low-frequency STN-DBS (60– 80 Hz) provided superior benefits for sleep quality and anxiety compared to conventional high-frequency stimulation while maintaining equivalent motor and cognitive outcomes. These findings support personalized programming strategies targeting specific non-motor symptoms in PD patients.Keywords: Parkinson’s disease, deep brain stimulation, subthalamic nucleus, non-motor symptoms, programming strategies, sleep disorders, cognitive function, mood disorders