Computer-Guided Deep Brain Stimulation (DBS) Programming for Parkinson
Heldman DA, Pulliam CL, Urrea Mendoza E, Gartner M, Giuffrida JP, Montgomery EB Jr, Espay AJ, Revilla FJ. Computer-Guided Deep Brain Stimulation (DBS) Programming for Parkinson Neuromodulation, 2016 Feb;19(2):127-32. doi: 10.1111/ner.12372. Epub 2015 Dec 1. PMID: 26621764
Introduction: The efficacy of DBS surgery for Parkinson’s disease (PD) is well known. However there has to be effective follow-up programming after the surgery for continued success of the device to control symptoms of PD. There are multiple challenges with programming including finding an expert programmer, programmers being available only in larger cities/medical centers, not overwhelming and exhausting the patient during time consuming programming, necessary individualized settings, and great variability in approaches across institutions. Typically programmers use subjective measures such as the Unified Parkinson’s Disease Rating Scale (UPDRS) to measure symptom control, however additional studies have found incorporating objective computer based measurements increase ease, efficacy, and stability of the settings. Therefore the goal of this research was to evaluate using such a process to determine optimal DBS settings.
Method: Seven people (2 women, mean age 54-71; PD duration 6-17 years) with Parkinson’s disease (PWP) that had recent bilateral DBS of the subthalamic nucleus (STN) were studied. Each PWP came back for programming a few days after sugery, off medication, and had a motion sensor placed on “the index finger of the participant’s more affected hand.” Due to time constraints, only the lead on the contralateral side was programmed using this method and the ipsilateral lead was turned off. The programming settings were made by a clinician at the direction of multiple algorithms created by a computer program based on the tremors and bradykinesia in various activities of the PWP. The clinician was able to intervene if the PWP was having side effects of any setting. An “internal symptom response map” was created for each PWP regarding optimal settings for symptom control, reduced side effects, and optimization of battery usage.
Results: An “Internal symptom response map” was successfully created for each PWP. Each PWP had approximately 35% improvement in tremor and bradykinesia.
Conclusion: The computer based programming was successful in all of the PWP. The settings were found to improve symptoms of PD while also showing care and caution about safety and side effects of the PWP. The findings of this study are very promising as it may open up access to those in rural settings or those without access to “expert” programmers. It also addresses the need for individualized settings that are based on objective measurements. As in all research studies there were limitations to this study. As this research is in its infancy, only monopolar programming was evaluated and it was suggested that for optimal symptom control that bilateral programming was necessary. Additionally, only two motor symptoms were studied, tremor and bradykinesia. Including rigidity, another common symptom in PD, would be beneficial. There also remains the concern regarding the amount of time needed to complete the programming to minimize PWP fatigue while at the same time giving enough time for the programmed setting to show an effect. It was suggested that instead of including many different motor variables that it would make more sense to choose those motor symptoms based on various factors to reduce the necessary programming time. There are also no long term studies on using such a method so it is promising to see the benefits but research should continue to monitor for improvements as well as possible adverse effects over time. Simply, as the researchers appropriately concluded, this study is a first in many necessary steps to evaluate computer based programming of DBS in PWP.