Abstract Details

Title Deep Brain Stimulation Programming in Parkinson's Disease Using Functional Motor Symptom Response Tuning Maps

Topic Movement Disorders

Presentation(s) P04 - (-)

Poster/Presentation
Number 180

Objective

Background BACKGROUND: Once pharmaceutical interventions are no longer effective in the management of PD motor symptoms, DBS surgery may be considered. While guidelines exist for DBS parameter optimization, efficacy is greatly dependent on programming experience and tools available to track response to stimulation over time.

Design/Methods DESIGN/METHODS: Subjects underwent routine outpatient programming sessions at approximately one, two, and four months following DBS surgery. During the programming, subjects were equipped with a finger-worn motion sensor which recorded kinematic data while subjects performed standardized tasks to evaluate rest and postural tremor and hand movement speed and amplitude deficits at various stimulation settings. Tuning maps displaying 0-4 color-coded symptom severity scores versus stimulation amplitude and contact were generated using clinician and clinically-validated motion-sensor ratings. In order to better compare tuning maps across programming sessions, stimulation voltage was converted to therapeutic current based on electrode impedance.

Results RESULTS: Electrode impedance increased and therefore higher stimulation amplitudes were necessary over subsequent programming sessions. High agreement between clinician and algorithm scoring was achieved for rest and postural tremor; however, clinician scores were more correlated with hand movement amplitude than speed deficits. Lastly, because electrode impedance did not remain constant across programming sessions, the stimulation amplitude threshold where the therapeutic effect occurred differed when comparing the voltage- versus current-based tuning maps.

Conclusions CONCLUSIONS: Functional motor response to stimulation and electrode impedance can vary over time, and as a result optimizing programming outcomes can be complex and challenging. Motion sensor tuning maps provide a standardized and objective approach to quickly visualize the therapeutic response to stimulation within and across programming sessions.

Authors/Disclosures
PRESENTER	No disclosure on file
Jerrold L. Vitek, MD, PhD (UMN Neurology)	Dr. Vitek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Vitek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Vitek has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Vitek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Surgical Information Sciences. Dr. Vitek has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Surgical Information Sciences. Dr. Vitek has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Vitek has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Boston Scientific. The institution of Dr. Vitek has received research support from NINDS.
Joseph Giuffrida, PhD	No disclosure on file
Elizabeth Ackermann, PhD (ISIS PHARMACEUTICALS, INC)	No disclosure on file
Gavin Giovannoni, MD (QMUL)	Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck KGaA. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche-Genentech. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astoria Biologica. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medscape.

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