Objective: To compare acute outcomes from Parkinson’s disease patients implanted with Deep Brain Stimulation (DBS) programmed using Algorithm Guided Programming (AGP) versus conventional, standard of care (SoC) programming.

Background: Motor symptoms from Parkinson’s Disease (PD) usually can be managed with pharmacology and DBS. As DBS systems continue to evolve, the options (contact numbers, directionality, current steering, etc.) available to manage patients, has made the therapeutic space much larger providing more options, while also creating additional challenges on clinicians programming these systems. AGP was developed with the intent of simplifying programming, allowing clinicians to focus on evaluating patient-specific symptoms, while the algorithm recommends stimulation settings for the clinician to explore the search space.

Method: For this ongoing, prospective study, patients previously implanted with a DBS system targeting bilateral subthalamic nucleus or internus globus pallidus were selected. These patients had received an optimized DBS therapy program per SoC (e.g. monopolar review or image guided programming at activation, followed by standard DBS programming optimization). For this study, MDS-UPDRS III scores (meds off) were evaluated by their treating neurologist during a single-visit in clinic. During this visit, AGP (StimSearch, Boston Scientific) was first assessed to establish the AGP-program. Subsequently, the clinician conducted an acute double-blinded evaluation of both AGP-derived program and the walk-in SoC-program with clinician determined wash-in/wash-out periods between programs.

Results: Preliminary results across 4 patients and 7 leads show improved MDS-UPDRS III by AGP when compared to Baseline pre-implant by 27%.  In an acute blinded comparison with walk-in settings derived via standard of care, per lead AGP-improved symptoms by 65%. During AGP, clinicians primarily evaluated two or more symptoms and used recommended electrode configurations at their chosen pulse width and frequency. To date, all subjects tested have gone home with AGP-derived programs.

Conclusion: AGP effectively provided guidance to clinicians evaluating multiple PD symptoms through DBS programming, and delivered outcomes that are comparable to standard of care. Further studies are needed to evaluate AGP at the activation of a DBS system (e.g. initial programming), as well as at longer time points.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/using-algorithm-guided-programming-to-treat-parkinsons-disease-patients-implanted-with-deep-brain-stimulation/