Objective: We evaluated the effect of at-home adaptive deep brain stimulation (aDBS) based on personalized neural biomarkers on motor symptoms and quality of life (QoL) in five patients with Parkinson’s disease (PD).

Background: DBS at continuous amplitudes (cDBS) is an effective therapeutic option for PD, but residual motor fluctuations can limit the therapeutic window. In-clinic and brief at-home algorithms that adjust stimulation based on invasive neural biomarkers of PD have shown better clinical results than cDBS [1-3]. The effectiveness of blinded at-home aDBS has never previously been reported.

Method: We included five PD patients with electrodes in the subthalamic nucleus (STN) and sensorimotor cortex connected to an investigational sensing-enabled DBS device. A movement disorders neurologist characterized residual bothersome symptoms in collaboration with the patient (bradykinesia, dyskinesia, stimulation-induced dysarthria, peak-dose dystonia) and determined cDBS and aDBS stimulation amplitudes. We used non-parametric cluster-based permutation tests and linear discriminant analysis to identify symptom-related neural signals, not restricting our analysis to a priori defined frequency bands. We compared aDBS to cDBS in a single-blind manner. Stimulation conditions were applied in randomized blocks of 1-4 days for a total of 5-30 days per condition at patient’s homes. As outcome measures, we obtained patients’ self-reports, wearable data for continuous symptom monitoring, and QoL scores (EQ-5D).

Results: Patients remained blinded and guessed stimulation conditions at chance level. The optimal signals for adaptive control varied across patients. We used STN activity (beta or finely tuned gamma power) for two patients and cortical signals (theta or finely tuned gamma power) for three cases. A linear mixed-effects model showed that aDBS using individualized biomarkers improved bothersome symptoms compared to cDBS without worsening of remaining symptoms. This was confirmed by wearables. In four out of five patients, aDBS improved QoL.

Conclusion: This is the first study to demonstrate the effectiveness of aDBS in a real-life setting. We demonstrate positive effects on motor fluctuations and QoL over a period of several weeks.

References: [1] Little et al. Annals of neurology, 2013
[2] Arlotti, Neurology, 2018
[3] R. Gilron et al., Nat. Biotechnol., 2021.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/at-home-adaptive-deep-brain-stimulation-improves-motor-fluctuations-and-quality-of-life-in-patients-with-parkinsons-disease-a-single-blind-randomized-study/