Objective: This is a case report of Parkinson’s disease (PD) patients who underwent deep brain stimulation (DBS) surgery and were remotely monitored using a validated telemonitoring system. The effectiveness of telemonitoring in adjusting DBS settings and medication post-operation is demonstrated.

Background: Ongoing medication management is essential after advanced therapies [1], also considering that DBS may result in stimulation-related motor symptoms, such as dyskinesia and gait disturbances [2]. Objective telemonitoring using wearables has been proposed for managing PD patients who require or are under advanced therapies, like DBS [3]. There is limited evidence though for the feasibility of telemonitoring to remotely fine-tune DBS settings [4], [5]. This study aims to explore the effectiveness of telemonitoring for DBS and medication optimization post-surgery.

Method: Two PD patients were treated by the same expert Neurologist (C.S.). One male, 62 years old (p1), diagnosed at age 45 and one male 68 years old (p2) diagnosed at age 43. P1 was monitored with a telemonitoring device for more than a year pre-DBS, with monthly recording sessions of at least 3 days. P2 started being telemonitored four months pre-DBS, with the same frequency and duration. P1 was taking 7 doses of levodopa (825 mg total) pre-DBS and P2 was into 5 doses of levodopa (875 mg total). Both patients were suffering from fluctuations pre-DBS and the treating physician was able to decrease the OFF-time experienced throughout the day, albeit with a significant toll on dyskinesia; both patients experienced troublesome chorea. These symptoms were evident in the telemonitoring reports and the physician decided to proceed with DBS. P1 was operated on in May 2023 and p2 in July 2023. Telemonitoring was still used in the months post-operation, with the physician proceeding with DBS settings and medication adjustments to optimize the status of both patients.

Results: Both patients experienced significant improvements after a few months of adjustments through telemonitoring. For p1 tremor, dyskinesia and OFF-time were considerably suppressed (Fig 1). This effect was sustained with levodopa reduced to 425 mg (Fig 2). For p2 OFF-time, dyskinesia, gait impairment and freezing significantly improved (Fig 3). Levodopa was limited to 150 mg (Fig 4).

Conclusion: These two cases show that telemonitoring can be used effectively to optimize DBS settings and medication regimen.

Figure 1

Figure 2

Figure 3

Figure 4

References: [1] A. Fasano et al., (2016). “Medical Management of Parkinson’s Disease after Initiation of Deep Brain Stimulation.” Canadian Journal of Neurological Sciences / Journal Canadien Des Sciences Neurologiques, vol. 43, no. 5, pp. 626-634. doi: 10.1017/cjn.2016.274.
[2] T. Morishita et al. “Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies.” Parkinsonism Relat Disord. 2010, vol. 16, no. 3, pp. 153-162. doi: 10.1016/j.parkreldis.2009.10.003.
[3] S. Marceglia et al., “Deep brain stimulation: is it time to change gears by closing the loop?,” J. Neural Eng., vol. 18, no. 6, p. 061001, Aug. 2021, doi: 10.1088/1741-2552/ac3267.
[4] A. Fasano et al., “Management of Advanced Therapies in Parkinson’s Disease Patients in Times of Humanitarian Crisis: The COVID‐19 Experience,” Mov. Disord. Clin. Pract., vol. 7, no. 4, pp. 361–372, May 2020, doi: 10.1002/mdc3.12965.
[5] C. D. Esper et al., “Necessity and feasibility of remote tele-programming of deep brain stimulation systems in Parkinson’s disease,” Parkinsonism Relat. Disord., vol. 96, pp. 38–42, Mar. 2022, doi: 10.1016/j.parkreldis.2022.01.017.

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