Survey of common deep brain stimulation programming practices by experts in Parkinson's Disease

J E Cunningham; L Y Cabrera; A Mahajan; S Aslam; S De Jesus; R Brennan; J Jimenez-Shahed; C C Aquino; T Xie; E O Vaou; N Patel; M Spindler; K A Mills; L Zhang; J Bertoni; C Sidiropoulos; S Miocinovic; B L Walter; F Panov; S E Zauber; H Sarva

doi:10.1007/s00415-024-12751-0

Survey of common deep brain stimulation programming practices by experts in Parkinson's Disease

J Neurol. 2024 Dec 12;272(1):49. doi: 10.1007/s00415-024-12751-0.

Authors

J E Cunningham¹, L Y Cabrera², A Mahajan³, S Aslam⁴, S De Jesus⁵, R Brennan⁶, J Jimenez-Shahed⁷, C C Aquino⁸, T Xie⁹, E O Vaou¹⁰, N Patel¹¹, M Spindler¹², K A Mills¹³, L Zhang¹⁴, J Bertoni¹⁵, C Sidiropoulos¹⁶, S Miocinovic¹⁷, B L Walter¹⁸, F Panov¹⁹, S E Zauber²⁰, H Sarva²¹

Affiliations

¹ College of Human Medicine, Michigan State University, East Lansing, MI, USA.
² Department of Engineering Science and Mechanics, Center for Neural Engineering, and Rock Ethics Institute, The Pennsylvania State University, W-316 Millennium Science Complex, University Park, PA, 16802, USA. lcabrera@psu.edu.
³ Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, 40059, USA.
⁴ Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
⁵ Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA.
⁶ Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
⁷ Department of Neurology, Bonnie and Tom Strauss Movement Disorders Center, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA.
⁸ Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4P1, Canada.
⁹ Parkinson's Disease and Movement Disorder Clinic and DBS Program, Department of Neurology, University of Chicago Medicine, Chicago, IL, 60637, USA.
¹⁰ Parkinson's Disease and Movement Disorders Division, Department of Neurology, UTHealth San Antonio, San Antonio, TX, 78229, USA.
¹¹ Department of Neurological Sciences, RUSH Parkinson's Disease and Movement Disorders Clinic, RUSH University Medical Central, Chicago, IL, 60612, USA.
¹² Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA.
¹³ Johns Hopkins Parkinson's Disease and Movement Disorder Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
¹⁴ Department of Neurology, The PF Center of Excellence for Movement Disorders and Neurorestoration, University of California Davis School of Medicine, Sacramento, CA, 95817, USA.
¹⁵ Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
¹⁶ Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, 48823, USA.
¹⁷ Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30329, USA.
¹⁸ Department of Neurology, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
¹⁹ Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
²⁰ Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
²¹ Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA.

PMID: 39666124
DOI: 10.1007/s00415-024-12751-0

Abstract

Objective: Identify consensus and variability in deep brain stimulation (DBS) programming practices for Parkinson's disease.

Background: DBS programming relies on the personal experience and skills of programmers. Despite consensus statements, there aren't official guidelines for DBS programming, making it likely for protocols to vary among providers.

Methods: We administered an online survey to the Functional Neurosurgery Working Group of the Parkinson's Study Group to capture those actively programming DBS patients. We performed descriptive statistics and comparisons of responses based on career stage: early (0-10 years) versus later (>10 years).

Results: Boston Scientific (n = 15/31, 48%) and Medtronic (n = 14/35, 40%) are the two DBS systems ranked as most used, with less reported frequency of Abbott devices (n = 4/32, 12.5). Traditional monopolar review ranked as the most common initial programming strategy by 23/29 (79%) respondents, regardless of the device type implanted. Monopolar omnidirectional testing was the most often used approach for contact configuration at initial programming (24/33, 73%).For treating dyskinesia, tremor, bradykinesia, rigidity, speech-related side effects, non-motor adverse effects, or swallowing-related side effects, the most likely optimization strategy selected was to modify amplitude of the active contact. When treating freezing of gait, there was a divergence between first modifying amplitude (n = 11/29, 38%) or frequency (n = 12/33, 36%).

Conclusion: Initial programming practices generally align with published recommendations, which can reassure less experienced clinicians in practices with near consensus and allow them to devote more time to areas with wider variety of practice. Our data also highlights aspects of DBS programming with less consensus, demonstrating the need for future evidence.

Keywords: Deep brain stimulation; Parkinson disease; Programming.

MeSH terms

Deep Brain Stimulation* / methods
Humans
Parkinson Disease* / therapy
Surveys and Questionnaires