Objective: Compare the use of in-clinic sensing functionality and standard of care monopolar review for identifying optimal settings of a deep brain stimulation (DBS) in Parkinson’s disease (PD).

Background: Optimizing DBS programming for movement disorders requires a trial-and-error process evaluating clinical benefit and adverse effects. Recent advances in sensing technology may enable improvements in selecting optimal settings. The use of this technology in programming and comparing clinical outcomes to standard of care have not been fully evaluated.

Method: Five PD patients (post dx = 47.8 ± 8.93 years; n = 9 hemispheres) with bilateral STN DBS and sensing capable battery replacement (post org. surgery: 6.8 ± 1.3 years;) were recruited. An initial bipolar review was used to find the contact with maximum beta power. Programming of the contact was then performed with pulse width (60us) and frequency (130Hz) held constant; amplitude was adjusted to maximize clinical benefit without inducing adverse effects. Two additional settings at 30us and 90us with energy-normalized mA while maintaining at 130Hz were performed. In a double blinded fashion, the clinical outcomes using items 3.3 (rigidity), 3.4-3.8 (bradykinesia), and 3.15-3.18 (tremor) of the MDS-UPDRS for unilateral symptoms of five conditions were tested: 1) Entry parameter settings, 2) off-stimulation, 3) beta contact at 30us, 4) beta contact at 60us, and 5) beta contact at 90us. The summations of the items of the MDS-UPDRS as well as sub scores were then compared for all conditions as well as the patient and clinician preference condition.

Results: A peak within the beta range was identified in all hemispheres. The entry settings (including ILS and bipolar/double monopolar) matched with the contact with the greatest beta power 5/9. There was no significant difference between any of the stimulation conditions. The clinician and patient preferred one of the settings with maximal beta 7/9, 5/7, respectively. In 4/9 of hemispheres, the patient was changed to one of the test conditions compared with entry settings.

Conclusion: This pilot study demonstrates that beta activity assessed in the clinical setting is feasible, and programming based upon the contact with the maximal beta power provides at least clinical equivalence to standard of care and potential added benefit in PD patients with STN DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pilot-study-to-investigate-the-use-of-in-clinic-sensing-to-identify-optimal-stimulation-parameters-for-deep-brain-stimulation-therapy-in-parkinsons-disease/