Neurologist University of Miami School of Medicine, United States
Introduction: Parkinson's disease (PD) motor symptoms usually are managed with pharmacology and Deep Brain Stimulation (DBS). As DBS systems continue to evolve, the availability of patient management options (i.e., contact numbers, directionality, current steering, etc.) allows for a larger therapeutic space, but this can create additional challenges for clinicians. AGP was developed to simplify programming, thereby allowing for greater focus on evaluating patient-specific symptoms, per algorithmic-recommended stimulation settings for exploration of the search space. Here, we assess acute outcomes from PD patients implanted with DBS programmed using algorithm-guided programming (AGP) versus conventional, standard of care (SoC) programming.
Methods: Selected study participants were previously implanted with a DBS system targeting bilateral subthalamic nucleus or internus globus pallidus. These patients 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 Ill scores (meds off) were evaluated by the treating neurologist during a single-visit in clinic. During this visit, AGP (StimSearch, Boston Scientific) was first assessed to establish the AGP-program. Subsequently, an acute double-blinded evaluation of both AGP-derived program and the walk-in SoC-program was conducted with clinician-determined wash-in/wash-out periods between programs
Results: Preliminary results across 4-patients and 7-leads show improved MDS-UPDRS Ill by AGP when compared to Baseline pre-implant by 27%. In an acute, blinded comparison with walk-in settings derived via SoC, per lead AGP-improved symptoms by 65%. During AGP, clinicians primarily evaluated two or more symptoms and used recommended electrode configurations at specific pulse-width and frequency. To date, all patients 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 SoC. Further studies are needed to evaluate AGP upon activation of the DBS system (e.g. initial programming), as well as at longer time-points.
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