Objective: The added benefit from adaptive (aDBS) compared with conventional deep brain stimulation (cDBS) is largely heterogeneous, and the perceived benefit is subjective. In this work, we aim to explore a personalized score to catch meaningful difference between the two DBS modes and so explaining patient’s preference

Background: DBS devices able to deliver closed-loop DBS are now available for patients. Preliminary evidence suggests that aDBS is preferred over cDBS in a large percentage of patients, but the clinical scales used to measure the effect of DBS do not always reflect patient preference, which depends on multiple factors, both objective and subjective.

Method: We reviewed data collected in a pilot study of 11 patients who received aDBS and cDBS for 2 weeks in each mode, in random order, from a fully implantable pulse generator. The Unified Parkinson’s Disease Rating Scale part III (UPDRS III) and the Hauser patient’s 3-day diary to assess good on time (GOT, on time without troublesome dyskinesia) were administered at the end of each 2-week session. Afterward, they blindly expressed their preference. We defined a combined score of these two measures by calculating the difference between the UPDRS III and the GOT in aDBS vs cDBS, then transforming this difference into minimal clinically important difference (MCID, defined as 4.83 UPDRS III points, and 2h of GOT). Finally, we summed the difference in MCID obtained using UPDRS III and GOT, and compared it to the blind preference expressed by the patient.

Results: Nine out of 11 patients preferred aDBS, and 2 cDBS. Considering UPDRS III alone, only 6 patients who preferred aDBS had a significant difference in favor of aDBS, and 1 of cDBS. Considering GOT alone, only 3 patients who preferred aDBS had a significant difference in favor of aDBS, while 2 had a significant difference for cDBS. Using our combined score, 7 out of 9 patients preferring aDBS showed a significant difference in favor of aDBS, and only 1 for cDBS.

Conclusion: Patient preference for DBS modes is guided by multiple factors that cannot be captured by single scales. Our combined score, which includes an objective assessment of motor symptoms and a patient-reported evaluation of motor state, proved more accurate than clinical scales alone and opens the way for new and more complex customized scores for patient monitoring.

References: [1] Ioannis U. Isaias, Sara Marceglia, Linda Borellini, Enrico Mailland, Filippo Cogiamanian, Sergio Barbieri, Antonella Ampollini, Elena Pirola, Luigi Remore, Laura Caffi, Chiara Palmisano, Claudio Baiata, Salvatore Bonvegna, Luigi Romito, Roberto Eleopra, Vincenzo Levi, Anna Rita Bentivoglio, Carla Piano, Alessandro Izzo, Maurizio Zibetti, Leonardo Lopiano, Michele Lanotte, Tomasz Mandat, Filippo Tamma, Mattia Arlotti, Costanza Conti, Lorenzo Rossi, Guglielmo Foffani, Andres Lozano, Elena Moro, Jens Volkmann, Marco Locatelli, Alberto Priori. Chronic adaptive versus conventional deep brain stimulation in Parkinson’s disease: a blinded randomized pilot trial. MedXRiv[Preprint] 2025 doi: https://doi.org/10.1101/2025.02.20.25322374

[2] Sánchez-Ferro Á, Matarazzo M, Martínez-Martín P, et al. Minimal Clinically Important Difference for UPDRS III in Daily Practice. Movement Disord Clin Pract 2018; 5: 448–50

[3] Okun MS, Gallo BV, Mandybur G, et al. Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 2012; 11: 140–9

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MDS Abstracts - https://www.mdsabstracts.org/abstract/beyond-updrs-personalizing-the-assessment-of-different-dbs-modes/