Low vs high frequency deep brain stimulation for Parkinson's disease-associated motor symptoms: A systematic review and meta-analysis of randomized control trials

Abstract

Purpose Deep brain stimulation (DBS) is an established treatment for motor symptoms in Parkinson's Disease (PD), but the optimal stimulation frequency remains uncertain. Previous studies have suggested that low and high frequency DBS may produce different clinical effects. This study aimed to compare the effects of low versus high frequency DBS on motor outcomes in PD. Methods A systematic review and meta-analysis of randomized controlled trials was conducted. PubMed, Ovid, CINAHL, Clinicaltrials.gov and the Cochrane Library were searched from 2010 to November 26, 2025. Studies comparing low and high frequency DBS in patients with PD were included. Motor outcomes were pooled using a random-effects model, and subgroup analyses were performed based on age and disease duration. Results A total of 15 randomized controlled trials involving 416 participants were included. Overall, no significant difference in motor outcomes was observed between low and high frequency DBS. Subgroup analysis based on age showed no significant effect modification. However, subgroup analysis suggested greater improvement with high frequency DBS in patients with shorter disease duration, whereas no significant difference was observed in those with longer disease duration. Sensitivity analyses demonstrated that these findings were robust. Additionally, tremor improvement favored the use of HFDBS. Conclusion High and low frequency DBS appear to provide comparable overall motor benefit in PD. Stimulation frequency may have differential effects depending on disease duration, although these findings should be interpreted cautiously. Further prospective trials are needed to determine optimal programming strategies across disease stages. Registration This study was registered on PROSPERO (CRD420251238009).