2025 American Academy of Neurology Abstract Website

Corneliu Luca¹, Yi-Han Lin², Zachary Jordan³, Neepa Patel⁴, Jonathan Jagid¹, Kimmy Su⁵, Brian Dalm⁶, Viviana Torres Ballesteros¹, Rajat Shivacharan⁷, Lisa Moore⁷
¹University of Miami School of Medicine, ²University of Washington, Neurology, ³Ohio State University Wexner Medical Center, ⁴Rush University Medical Center, ⁵University of Washington Medical Center, ⁶Ohio State University Medical Center, ⁷Boston Scientific Neuromodulation

Objective:

Here, we assess acute outcomes from Parkinson's disease (PD) patients implanted with Deep Brain Stimulation (DBS) programmed using algorithm-guided programming (AGP) versus conventional, standard of care (SoC) programming.

Background:

PD motor symptoms usually are managed with pharmacology and 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.

Design/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.

Conclusions:

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.