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Programming Adaptive Deep Brain Stimulation in the Clinic: Lessons from the ADAPT-PD Trial

T. Herrington, M. Beudel, J. Ostrem, S. Little, L. Almeida, A. Ramirez-Zamora, A. Fasano, T. Hassell, K. Mitchell, E. Moro, M. Gostkowski, N. Sarangmat, S. Stanslaski, L. Tonder, Y. Tan, R. Summers, T. Goble, R. Raike, H. Bronte-Stewart (Boston, USA)

Meeting: 2024 International Congress

Abstract Number: 699

Keywords: Deep brain stimulation (DBS), Parkinson’s

Category: Parkinson’s Disease: Clinical Trials

Objective: To present data and lessons learned from the ADAPT-PD trial

Background: Adaptive deep brain stimulation (aDBS) will require strategies for efficient and effective aDBS programming.

Method: The ADAPT-PD Trial (NCT04547712) is an international, multicenter, prospective, single-blind, randomized crossover pivotal trial of at-home aDBS in patients with Parkinson’s disease. Investigational software unlocked two aDBS modes, single threshold (ST) and dual threshold (DT) modes, respectively, driven by fast and slow changes in local field potential power (8-30 Hz). aDBS programming steps include optimizing upper and lower stimulation limits, LFP threshold(s), stimulation ramp times and detection blanks, confirming aDBS performance with clinical examination, and patient feedback. Programming success rates, typical parameters, and patient preferences between modes are reported.

Results: 68 patients underwent aDBS programming. Physicians optimized aDBS modes over a 60-day period with at least one aDBS mode deemed acceptable in 60 (88%) and both modes in 43 (63%). 55 (81%) tolerated DT and 48 (71%) tolerated ST. Ramp up time rates were 664±1088ms for ST and 2.1±0.7min for DT. Ramp times were left at device pre-sets in 65% (ST) and 72% (DT) of patients. Detection blank durations were left at device pre-sets in 61% (ST) and 73% (DT) of patients. Mean stimulation amplitudes were 2.3±0.9 mA for ST and 2.5±1.0mA for DT modes. The mean difference between upper and lower stimulation limits were 0.8±0.5mA for ST and 0.9±0.6mA for DT, representing 33% and 35% of the mean stimulation current, respectively. 59/60 participants chose to continue on aDBS in long-term follow-up (24 ST and 35 DT).

Conclusion: aDBS programming was feasible in ADAPT-PD. DT mode aDBS was better tolerated and preferred at a higher rate compared to ST mode. After stimulation limits and LFP thresholds were individualized, default settings for stimulation ramp rates and blanking durations were used for a majority of patients. There were lessons learned to optimize stimulation limits, thresholds, ramp rates, and detection blanks. A workflow will be presented for efficient aDBS programming, including recommendations for control signal selection, information to be gathered during initial cDBS programming, initial aDBS parameter selection and long-term refinement.

To cite this abstract in AMA style:

T. Herrington, M. Beudel, J. Ostrem, S. Little, L. Almeida, A. Ramirez-Zamora, A. Fasano, T. Hassell, K. Mitchell, E. Moro, M. Gostkowski, N. Sarangmat, S. Stanslaski, L. Tonder, Y. Tan, R. Summers, T. Goble, R. Raike, H. Bronte-Stewart. Programming Adaptive Deep Brain Stimulation in the Clinic: Lessons from the ADAPT-PD Trial [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/programming-adaptive-deep-brain-stimulation-in-the-clinic-lessons-from-the-adapt-pd-trial/. Accessed May 9, 2025.
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