Efficiency and efficacy of sensing-monopolar recordings from the subthalamic nucleus in Parkinson's disease at initial programming: a comparison to traditional methodology

BackgroundOptimizing deep brain stimulation (DBS) in Parkinsons disease (PD) requires a complex process for evaluating clinical benefit and adverse effects. Localizing the contact with maximum beta (13-30Hz) power using a novel in-clinic sensing-monopolar (SenseMP) recording may improve the efficiency of selecting clinically optimal DBS settings. ObjectiveCompare the clinical outcomes of optimal programming settings determined by SenseMP versus standard-of-care monopolar review (ReviewMP) for DBS therapy in PD. MethodsTen PD patients (4F/6M, post-diagnosis = 9.2 {+/-} 3.5 years; on/off percent change = 43.7 {+/-} 14.0) with bilateral subthalamic nucleus (STN) DBS were recruited. Independent evaluation of unilateral STN DBS was assessed with both SenseMP to identify the DBS contact detecting maximum beta peak power and ReviewMP. MDS-UPDRS Part III assessments for unilateral symptoms were compared between SenseMP and ReviewMP, and the time to complete these two conditions was recorded. ResultsChange from baseline in overall clinical outcomes did not differ between conditions (SenseMP = 60.5%, ReviewMP = 60.1% (p = 0.85); 19 hemispheres), nor were there differences in sub-analysis for bradykinesia, rigidity, and tremor. Using SenseMP to identify and conduct single contact ReivewMP was more time efficient than ReviewMP: 17.1 {+/-} 4.2 minutes vs. 129.9 {+/-} 24.9 minutes (p = 3.6e-15). SenseMP identified the maximum beta contact in SenseBP pairs at a specific level (17/20 times). ConclusionThis study demonstrates that SenseMP localization of maximum beta peak power for DBS contact selection provides equivalent clinical efficacy to ReviewMP at a fraction of the required time.