Objective: With the growing availability of technology-guided deep brain stimulation (DBS) programming, it is increasingly challenging to determine when and how to use these technologies effectively. This study aims to evaluate the effectiveness of algorithm-guided DBS programming through a case series of 18 patients.

Background: DBS has been a standard treatment for Parkinson’s disease for 27 years, aiding in symptom management and reducing medication side effects. Recent advancements allow for personalized programming but introduce complexity in decision-making. 3D algorithmic technology helps create electric fields that target desirable areas while avoiding undesirable ones.

Method: Over 5 months, all eligible DBS patients were offered algorithm-guided programming. Patients with prior physician-guided programming (PGP) received a new algorithm-guided program (AGP). The AGP was developed based on custom made motor hotspots and avoiding the internal capsule. The field shape was maintained per algorithmic design, but amplitude was changed to be approximately equivalent to PGP. Clinical exam and patient experiences were compared between AGP and PGP. Patients could choose to continue with either program after a minimum one-week trial and choose a final program at follow up.

Results: 17 out of 18 patients agreed to try algorithmic programming. The cohort included patients with bilateral STN (8), GPi (5), and VIM (4) leads. Algorithm-guided programs were created in under 5 minutes per side. Clinical exams were similar between programming methods; however, 13 out of 18 patients reported a strong preference for one program over the other. 16 out of 18 chose to continue with AGP at the end of their visit, and 7 out of 12 remained on AGP at follow-up. Reported benefits included: improved bradykinesia, rigidity, reduced freezing, and improved speech. Side effects included: worse speech, poor tremor control, and worsening freezing.

Conclusion: Algorithm-guided programming is significantly faster than traditional methods of programming and produces complex programs with ease. Physician adjustments were needed to reach ideal amplitude settings on initial AGP programming. Many patients preferred algorithm-guided programming, but it will not replace the need for skilled programming and careful clinical examination.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outcomes-of-algorithm-guided-dbs-programming-a-case-series/