Abstract Details

Title Using Algorithm-guided Programming to Treat Parkinson's Disease Patients Implanted with Deep Brain Stimulation

Topic Movement Disorders

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-001

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.

Authors/Disclosures
Corneliu C. Luca, MD (University of Miami) PRESENTER	Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Luca has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Signant Health. Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott.
Yi-Han Lin, MD (University of Washington, Neurology)	The institution of Dr. Lin has received research support from UniQure. The institution of Dr. Lin has received research support from CHDI. The institution of Dr. Lin has received research support from Prilenia Therapeutics. The institution of Dr. Lin has received research support from Boston Scientific. The institution of Dr. Lin has received research support from BIAL.
Zachary B. Jordan, MD (Ohio State University Wexner Medical Center)	Dr. Jordan has nothing to disclose.
Neepa J. Patel, MD, FAAN (Rush University Medical Center)	Dr. Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie Pharmaceuticals. Dr. Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal Pharmaceuticals. Dr. Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernius Pharmaceuticals. Dr. Patel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boston Scientific.
Jonathan Jagid	Jonathan Jagid has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miami Dade County State Attorneys office. The institution of Jonathan Jagid has received research support from Boston Scientific.
Kimmy Su, MD (University of Washington Medical Center)	Dr. Su has nothing to disclose.
Brian Dalm, MD	Dr. Dalm has nothing to disclose.
Viviana Torres Ballesteros, Other	Ms. Torres Ballesteros has nothing to disclose.
Rajat Shivacharan	Dr. Shivacharan has received personal compensation for serving as an employee of Boston Scientific.
Lisa Moore, PhD	Dr. Moore has received personal compensation for serving as an employee of Boston Scientific .

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