Clinically Implemented Sensing-based Initial Programming of Deep Brain Stimulation for Parkinson's Disease: A Retrospective Study

Bart E K S Swinnen; Andrea Fuentes; Monica M Volz; Susan Heath; Philip A Starr; Simon J Little; Jill L Ostrem

doi:10.1016/j.neurom.2024.11.002

Clinically Implemented Sensing-based Initial Programming of Deep Brain Stimulation for Parkinson's Disease: A Retrospective Study

Neuromodulation. 2024 Dec 2:S1094-7159(24)01221-2. doi: 10.1016/j.neurom.2024.11.002. Online ahead of print.

Authors

Bart E K S Swinnen¹, Andrea Fuentes¹, Monica M Volz¹, Susan Heath¹, Philip A Starr², Simon J Little¹, Jill L Ostrem³

Affiliations

¹ University of California San Francisco Department of Neurology, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA.
² University of California San Francisco Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Department of Physiology, University of California San Francisco, San Francisco, CA, USA.
³ University of California San Francisco Department of Neurology, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA. Electronic address: [email protected].

PMID: 39625426
DOI: 10.1016/j.neurom.2024.11.002

Abstract

Objectives: Initial deep brain stimulation (DBS) programming using a monopolar review is time-consuming, subjective, and burdensome. Incorporating neurophysiology has the potential to expedite, objectify, and automatize initial DBS programming. We aimed to assess the feasibility and performance of clinically implemented sensing-based initial DBS programming for Parkinson's disease (PD).

Materials and methods: We conducted a single-center retrospective study in 15 patients with PD (25 hemispheres) implanted with a sensing-enabled neurostimulator in whom initial subthalamic nucleus/globus pallidus pars interna DBS programming was guided by beta power in real-time local field potential recordings, instead of a monopolar review.

Results: The initial sensing-based programming visit lasted on average 42.2 minutes (SD 18) per hemisphere. During the DBS optimization phase, a conventional monopolar clinical review was not required in any patients. The initial stimulation contact level remained the same at the final follow-up visit in all hemispheres except three. The final amplitude was on average 0.8 mA (SD 0.9) higher than initially set after the original sensing-based programming visit. One year after surgery, off-medication International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III total score, tremor subscore, MDS-UPDRS IV, and levodopa-equivalent dose improved by 47.0% (p < 0.001), 77.7% (p = 0.001), 51.1% (p = 0.006), and 44.8% (p = 0.011) compared with preoperatively using this approach.

Conclusions: This study shows that sensing-based initial DBS programming for PD is feasible and rapid, and selected clinically effective contacts in most patients, including those with tremor. Technologic innovations and practical developments could improve sensing-based programming.

Keywords: DBS; LFP; Parkinson’s disease; initial programming; sensing.