Objective: Compare the clinical outcomes of optimal settings between in-clinic monopolar sensing (MS) and standard of care monopolar review (MR) for deep brain stimulation in Parkinson’s disease.

Background: Optimizing deep brain stimulation (DBS) programming for movement disorders requires a trial-and-error process evaluating clinical benefit and adverse effects. A novel use of monopolar brain sensing may improve efficiency and selection of optimal settings. We hypothesize that a novel monopolar sensing strategy, utilizing local field potentials (LFP) in the beta frequency (13-30 Hz), will decrease the time required to identify the optimal contact configuration compared to standard monopolar review.

Method: Ten PD patients (4F/6M, post diagnosis = 9.2 ± 3.5 years; on/off percent change = 43.7 ± 14.0) with bilateral STN DBS were recruited. An initial monopolar sensing review of LFP beta power was assessed at the start of the study to determine the DBS lead electrode segment and/or level with maximum beta power. Upon completion of the sensing protocol, a monopolar review was conducted for all electrode levels and segments by a clinician blinded to the outcomes of the sensing results. 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 Part III for unilateral symptoms were assessed to compare between the two contact configurations derived from both the MS and MR conditions. The summations of the items of the MDS-UPDRS as well as sub scores were then compared for all conditions.

Results: MDS-UPDRS scores and sub-scores for rigidity, bradykinesia and tremor were not statistically different for 20 hemispheres between the MS and MR conditions (p > 0.05 for all). Both monopolar sensing and monopolar review resulted in similar improvements in percent change from OFF baseline: MS = 56.3% and MR = 50% (p = 0.75). Average duration for the monopolar sensing review was 18.3 ± 1.6 mins, compared to 124.3 ± 23.1 mins for traditional monopolar review (p < 0.0001).

Conclusion: This pilot study demonstrates that an MS strategy based on assessing LFP beta power to identify the likely optimal therapeutic contact is similar to standard MR in clinical efficacy, yet with a major advantage of being more time efficient.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/monopolar-sensing-improves-the-efficiency-of-dbs-programming-in-parkinsons-disease/