Objective: To evaluate the feasibility of an automated intermittent deep brain stimulation (DBS) sleep program in essential tremor (ET) patients with ventralis intermedius nucleus (VIM) implanted DBS.

Background: Some DBS patients may turn off stimulation during sleep to preserve battery life. Some barriers to doing this include severe tremor preventing falling asleep and inability to turn the DBS back on via patient remote. Preservation of DBS battery life without disrupting sleep could be achieved through an automated intermittent DBS sleep program: automatically turning their DBS off and back on based on the patient reported sleep schedule. While DBS controllers allow for an automated intermittent program, the feasibility of this program has not been tested in ET DBS patients.

Method: ET patients with unilateral or bilateral VIM DBS underwent a randomized, 3-week cross over study of the following conditions: A) continuously on, B) manually turned off before bedtime and back on upon awakening, C) automatically turned off 1 hour after bedtime and on 1 hour before awakening. At the end of each condition, the Parkinson’s Disease Sleep Scale (PDSS) modified for ET, Pittsburgh Sleep Quality Index (PSQI) sleep quality survey, Fahn-Tolosa-Marin Tremor Rating Scale (FTM), DBS data, and adverse events were collected. A patient preference survey was collected at the final visit.  All ten patients wore an Oura ring for continuous actigraphy monitoring.

Results: Eight out of ten patients preferred the conditions in which DBS was off at night. There was no significant difference in preference between being manually or automatically turned OFF. Analysis of FTM, PSQI, PDSS and Oura Ring data, showed there was no difference among the three conditions.

Conclusion: There was no difference in overall quality of sleep or symptom improvement with an automated intermittent DBS system compared to continuously leaving DBS on or manually turning DBS off at bedtime, as measured by tremor and sleep assessments. While patients preferred stimulation being off at night, the option of using the automated intermittent DBS program may be an advantage in some patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/patient-experience-during-automated-deep-brain-stimulation-dbs-changing-for-sleep-peace-study/