Mobile Application Deep Brain Stimulation Programming for Parkinson Disease Treatment

Deep brain stimulation (DBS) is a highly effective treatment for Parkinson disease (PD). However, the success of DBS hinges on the meticulous programming of the device, which can be arduous and time-consuming for patients, caregivers, and clinicians. To address this challenge, researchers developed the Mobile Application for PD DBS (MAP DBS), a clinical decision support system aimed at improving DBS programming efficiency. A recent article presents the findings of a clinical trial comparing standard DBS programming with MAP DBS-aided programming.

The study was an open-label, randomized, controlled, multicenter clinical trial conducted in the United States. It involved enrolling patients aged 30 to 80 who had received DBS treatment for idiopathic PD at six expert centers. The primary objective was to assess the time spent on DBS programming, while secondary outcomes focused on changes in motor symptoms, caregiver strain, and medication requirements.

The introduction section outlines the significance of DBS in treating PD and highlights the challenges associated with DBS programming. DBS programming involves fine-tuning the stimulation parameters to achieve optimal therapeutic effects, but the process can be cumbersome and requires multiple clinic visits. Clinicians often rely on trial-and-error methods due to the lack of patient-specific anatomical data, making the process inefficient.

To address these challenges, the researchers developed MAP DBS, a mobile decision support system that provides personalized computational models of activation to guide DBS programming. It allows clinicians to modify stimulation settings through an intuitive interface and visualize how the area of activation changes based on each patient's target nuclei. Prior pilot studies had shown promise in improving various aspects of DBS programming.

The hypothesis underlying this study was that MAP DBS could simplify the DBS programming process. To test this hypothesis, the researchers conducted a clinical trial comparing standard DBS programming (referred to as SOC) with MAP DBS-aided programming over a six-month period.

The results of the study showed several key findings:

• Reduction in Initial Visit Time: MAP DBS significantly reduced the time spent on the initial programming visit. Patients who received MAP DBS-aided programming spent an average of 27.4 minutes, while those in the SOC group spent 43.8 minutes. This reduction in initial programming time was statistically significant.
• No Significant Difference in Total Programming Time: While the initial visit time was reduced, there was no significant difference in the total programming time over the six-month study duration between the MAP DBS-aided group and the SOC group. This suggests that while MAP DBS streamlines the initial programming, it does not significantly impact the overall time spent on DBS programming.
• Improvement in Motor Symptoms: Patients who underwent MAP DBS-aided programming experienced a notable improvement in motor symptoms as measured by the Unified Parkinson's Disease Rating Scale (UPDRS III) on-medication scores. They demonstrated a greater reduction (-7.0 ± 7.9) compared to the SOC group (-2.7 ± 6.9) at six months, indicating that MAP DBS contributes to better clinical outcomes.

In conclusion, the study found that MAP DBS was well-tolerated and offered improvements in key aspects of DBS programming, including a significant reduction in initial visit time and a greater reduction in motor symptoms compared to standard programming. While it didn't significantly alter the total programming time, the positive impact on clinical efficacy suggests that MAP DBS holds promise as a valuable tool in optimizing DBS therapy for PD patients. This research represents a significant step toward enhancing the efficiency and effectiveness of DBS treatment, ultimately benefiting both patients and healthcare providers.

Reference: 

Duffley G, Szabo A, Lutz BJ, et al. Interactive mobile application for Parkinson's disease deep brain stimulation (MAP DBS): An open-label, multicenter, randomized, controlled clinical trial. Parkinsonism Relat Disord. 2023;109:105346. doi:10.1016/j.parkreldis.2023.105346