Objective: Compare the use of in-clinic monopolar sensing functionality and standard of care monopolar review for identifying optimal settings 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 sensing may improve efficiency and selection of optimal settings. We hypothesize that a novel monopolar sensing strategy, utilizing local field potentials in the beta frequency (13-30 Hz), will decrease the time required to identify the optimal contact configuration compared to standard monopolar review.

Method: Four PD patients (3F/1M, post diagnosis = 8.75 ± 1.5 years; on/off percent change = 50.8 ± 16.8) with bilateral STN DBS were recruited. An initial monopolar sensing review of power was assessed at the start of the study to determine the DBS segment and/or level with maximum beta power. After the sensing protocol which included monopolar and bipolar sensing, a standard monopolar review was conducted to identify the optimal segment based on therapeutic window. 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 were assessed to compare between the two contact configurations derived from both the monopolar sensing and monopolar review conditions. 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: The DBS contact configuration determined by monopolar sensing review with LFP beta power was preferred by patients in 6/8 hemispheres and by clinicians in 4/8 hemispheres. Average duration for the monopolar sensing review was 16.8 ± 1.2 mins, compared to 131.5 ± 17.3 mins for traditional monopolar review.

Conclusion: This pilot study demonstrates that using a monopolar sensing strategy, based on assessing beta frequency LFP power, to identify the likely optimal therapeutic contact, is similar to standard monopolar review in efficacy based on patient and clinician preference, but more time efficient.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pilot-study-to-investigate-the-use-of-monopolar-sensing-to-improve-the-efficiency-of-dbs-programming-in-parkinsons-disease/