Closed-loop programming using external responses for deep brain stimulation in Parkinson's disease

• Published in: Parkinsonism & related disorders 2021-03, Vol.84, p.47-51
• Main Authors: Sasaki, Fuyuko, Oyama, Genko, Sekimoto, Satoko, Nuermaimaiti, Maierdanjiang, Iwamuro, Hirokazu, Shimo, Yasushi, Umemura, Atsushi, Hattori, Nobutaka
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Automated programming; Closed loop programming; Cross-Over Studies; Deep brain stimulation; Deep Brain Stimulation - methods; Deep Brain Stimulation - standards; Double-Blind Method; Female; Humans; Male; Middle Aged; Neurophysiological Monitoring; Objective assessment; Outcome and Process Assessment, Health Care; Parkinson Disease - diagnosis; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Parkinson's disease; Severity of Illness Index; Subthalamic Nucleus - surgery; Wearable Electronic Devices; Wearable sensor
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2021.01.023

Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). Clinicians face various challenges in adjusting stimulation parameters and configurations in clinical DBS settings owing to inexperience, time constraints, and recent advances in DBS technology that have expanded the number of possible contact configurations. We aimed to assess the efficacy of a closed-loop algorithm (CLA) for the DBS-programming method using external motion sensor-based motor assessments in patients with PD. In this randomized, double-blind, crossover study, we enrolled 12 patients who underwent eight-ring-contact DBS lead implantations bilaterally in the subthalamic nucleus. The DBS settings of the participants were programmed using a standard of care (SOC) and CLA method. The clinical effects of both programming methods were assessed in a randomized crossover fashion. The outcomes were evaluated using the Unified Parkinson's Disease Scale part III (UPDRS-III) and sensor-based scores for baseline (medication-off/stimulation-off) and both programming methods. The number of programming steps required for each programming method was also recorded. The UPDRS-III scores and sensor-based scores were significantly improved by SOC and CLA settings compared to the baseline. No statistical difference was observed between SOC and CLA. The programming steps were significantly reduced in the CLA settings compared to those in the SOC. No serious adverse events were observed. CLA can optimize DBS settings prospectively with similar therapeutic benefits as that of the SOC and reduce the number of programming steps. Automated optimization of DBS settings would reduce the burden of programming for both clinicians and patients. •A randomized, double-blind, crossover study was performed to investigate a novel closed loop-deep brain stimulation programming algorithm.•A novel closed-loop algorithm using external motion sensor provided similar therapeutic benefit as that of the standard of care programming method.•Am novel closed-loop algorithm reduced the number of programming steps.