Objective: To explore the utility of remote patient monitoring, using a combination of brain sensing and objective outcome measurement, in the management of Parkinson’s disease (PD) patients with deep brain stimulation (DBS) devices.

Background: The current generation of FDA-approved DBS devices have the ability to sense neural activity, however the utility of real-world monitoring in informing clinical care is not yet fully explored. Initial findings with investigational devices suggest spectral signatures of Parkinsonian symptoms, which require real-world validation with objective metrics such as those generated by wearables. We explore three case studies of patients implanted with sensing-enabled DBS devices, who are concurrently equipped with wearable devices and self-report mobile applications. We aim to use these combined metrics to characterize patient symptomatology and to inform patient care.

Method: From a cohort of PD patients implanted with DBS for standard clinical care, three patients from three centers with concurrent neurophysiological and wearable data were analyzed. Patients were implanted with DBS leads in either the subthalamic nucleus (STN) or globus pallidus interna (GPi). Patients were also equipped with a wearable sensor and a mobile application for self-reporting medications and symptoms. We assessed correlations between neurophysiology and objective monitoring to characterize patient symptomatology.

Results: We assessed over two months of neurophysiology per patient, including passively-recorded power band trends and actively-recorded, patient-triggered frequency spectra, in conjunction with wearable-generated symptom labels and patient self-report. We validated previous findings indicating correlations between basal ganglia physiology and tremor and dyskinesia. We also observed physiological modulation in response to medication and circadian fluctuations.

Conclusion: Initial experience with real-world monitoring in DBS patients identifies neurophysiological correlates of PD symptoms, medication intake, and sleep. Equipping patients with wearable monitors and self-report tools provides important context for longitudinal neural recordings, which furthers our ability to characterize patient state(s) between clinical visits. Further studies with larger cohorts are needed to 1) formalize protocols for most effective data collection and 2) validate the utility of these datasets in informing clinical care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/early-experience-using-real-world-monitoring-to-inform-parkinsons-management/